Parathyroid Disorders

Parathyroid Disorders

Primary Hyperparathyroidism

• – Pathway/Axis:
  • parathyroid hormone
• – Major cause:
  • parathyroid adenoma – when one or more of the parathyroid glands grows into a tumor and secretes excess parathyroid hormone resulting in high blood calcium levels.
• Risk:
  • – osteoporosis, kidney stones, excessive urination, abdominal pain, tiring easily or weakness, depression or forgetfulness, and bone and joint pain.
• Management:
  • Surgery (even if a/sx; can still have indications)

Secondary Hyperparathyroidism

• Management:
  • Treatment of underlying cause (MC CKD)
    
  • Vitamin D and Calcium supplementation
    
  • Phosphate binders

Tertiary Hyperparathyroidism

• Management:
  • Surgical Removal (Parathyroidectomy)

Hypoparathyroidism

• -Pathway/Axis:
  • Parathyroid hormone
• – Major cause:
  • removal of all parathyroid glands via surgery to treat thyroid or laryngeal malignancy.
  • It also occurs when the body’s own white blood cells mistakenly attack the parathyroid gland and impair the production of PTH.
• – Major symptoms:
  • unpleasant or tingling around the mouth, in the hands and feet, as wells as muscle cramps, “tetany”, a severe spasm that affects the hands and feet.
• Management:
  • Acute and severe: IV calcium
    
  • Chronic (mild to moderate): Oral calcium + calcitriol + PTH + oral magnesium
    
  • Chronic (severe): Add HCTZ to above

Parathyroid adenoma

• Management:
  • Surgical removal

Osteoporosis

• Pathway/Axis:
  • Calcitonin- Parathyroid hormone (PTH) feedback loop
• – Major cause:
  • many different causes; typically due to a decrease in calcitonin secretion or an increase in PTH secretion.
• – Major symptoms:
  • greatly increases risk in bone fractures. fractures occur in situations where healthy individuals wouldn’t normally break a bone, like the vertebral column, rib, hip, and wrist.