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Hyperparathyroidism

Tue, 12/25/2007 - 11:57 — oxygen
Hyperparathyroidism Listen to Audio endocrine1.jpg Clinical causes Clinical manifestations Diagnosis Treatment Preoperative management Intraoperative management Postoperative management Clinical causes: Primary hyperparathyroidism -adenoma -carcinoma -hyperplasia of parathyroid gland secondary hyperparathyroidism -compensatory response to hypocalcemia due to an underlying primary disease (ex. renal disease) Clinical manifestations: General manifestations are due to effects of hypercalcemia. Possible causes of hypercalcemia may include: -hyperparathyroidism -bone metastasis -vitamin D intoxication -milk alkali syndrome -sarcoidosis CNS: delirium, psychosis, coma CVS: hypertension, ECG changes (ex. shortened QT interval) GI: nausea, vomiting, ileus, pancreatitis Renal: -impaired concentrating abilitiy of kidneys -hyperchloremic metabolic acidosis -polyuria, dehydration, polydipsia -renal stones -renal failure Diagnosis: Primary hyperparathyroidism -increased PTH with increased [Ca2+] Secondary hyperparathyroidism -increased PTH with decreased [Ca2+] Treatment Treatment (hypercalcemia from hyperparathyroidism): -hydration with normal saline -diuresis with furosemide goal: U/O = 200 - 300 cc/hr may require: -bisphonate: pamidronate 60-90 mg IV -calcitonin 2-8 U/kg SQ Treatment (surgical) -removal of all four parathyroid glands ex. for parathyroid hyperplasia -removal of a single parathyroid gland ex.adenoma of a single parathyroid gland Preoperative management: Assess volume status: -hydration with normal saline -diuresis with furosemide -goal having urine output approx 200 - 300 ml/hr Assess [Ca2+]: -should bring [Ca2+] below 14 mg/dL , 7 mEq/L or 3.5 mmol/L if [Ca2+] > 15 mg/dL then treat with: -bisphonate (pamidronate 60 - 90 mg) : preferred due to prolonged duration of action -calcitonin 2 -8 U/kg SQ Intraoperative management: CNS: -may involve excitatation, agitation and psychosis if Ca2+ levels are elevated CVS: inc.[Ca2+] secondary to hyperparathyroidism may lead to: -hypertension -short QT interval -ventricular dysrhythmias Resp: -avoid hypoventilation (respiratory acidosis) may further increased Ca2+ levels NMJ: -NMJ function may be altered therefore use caution with muscle relaxants Postoperative management: Similar complications/concerns with postoperative subtotal thyroidectomy -thyroid storm -recurent laryngeal ne Rve palsy -hematoma -hypoparathyroidism -pneumothorax

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