Hyperparathyroidism: Difference between revisions

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A 60 year old man presented with diplopia as well as common symptoms of hyperparathyroidism. He was diagnosed with primary hyperparathyroidism and a search for the cause of the diplopia continued. After undergoing thyroidectomy his double vision was relieved as his serum calcium levels returned to normal.  
A 60 year old man presented with diplopia as well as common symptoms of hyperparathyroidism. He was diagnosed with primary hyperparathyroidism and a search for the cause of the diplopia continued. After undergoing thyroidectomy his double vision was relieved as his serum calcium levels returned to normal.  


<br>Primary hyperparathyroidism presenting as recurrent acute pancreatitis: A case report and review of literature<ref name="11">Misgar R., Mathew V., Pandit K.,Chowdhury S., (2011) 'Primary hyperparathyroidism presenting as recurrent acute pancreatitis: A case report and review of literature', Indian J of Endocrinology and Metabolism, 15(1), pp. 54-56 [Online]. Available at: http://www.google.com/url?q=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3079873%2F&amp;sa=D&amp;sntz=1&amp;usg=AFQjCNHmCqNhGzCKTgvzqQwzESsUacGbpw (Accessed: 18th January 2014).</ref>  
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588946/pdf/yjbm00039-0061.pdf<br>
 
<br>Primary hyperparathyroidism presenting as recurrent acute pancreatitis: A case report and review of literature<ref name="11">Misgar R., Mathew V., Pandit K.,Chowdhury S., (2011) 'Primary hyperparathyroidism presenting as recurrent acute pancreatitis: A case report and review of literature', Indian J of Endocrinology and Metabolism, 15(1), pp. 54-56 [Online]. Available at: http://www.google.com/url?q=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3079873%2F&amp;amp;sa=D&amp;amp;sntz=1&amp;amp;usg=AFQjCNHmCqNhGzCKTgvzqQwzESsUacGbpw (Accessed: 18th January 2014).</ref>  


A 32 year old man presents with repetitive episodes of pancreatitis. Patient was treated by parathyroidectomy and recurrence of abdominal pain ceased and serum calcium levels normalized. <br>
A 32 year old man presents with repetitive episodes of pancreatitis. Patient was treated by parathyroidectomy and recurrence of abdominal pain ceased and serum calcium levels normalized. <br>

Revision as of 00:23, 3 April 2014

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Suzette Austin & Erica Jezke from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Top Contributors - Suzette Austin, Erica Jeszke, Lucinda hampton, Elaine Lonnemann, WikiSysop, 127.0.0.1, Kim Jackson and Admin  

Definition/Description
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Hyperparathyroidism is a disorder caused by oversecretion of parathyroid hormone (PTH) by one or more of the four parathyroid glands.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title This disorder can disrupt calcium, phosphate, and bone metabolism. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleThe parathyroid glands are located in the neck on the posterior surface of each lobe of the thyroid gland. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Each of the four parathyroid glands is about the size of a grain of rice.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title As part of the endocrine system, these glands secrete parathyroid hormone (PTH), which regulates calcium and phosphorus. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Hyperparathyroidism is classified into three groups: primary, secondary, or tertiary.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title 

Primary hyperparathyroidism develops when there is an imbalance between serum calcium levels and PTH secretion.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Secondary hyperparathyroidism occurs when the glands have become enlarged due to malfunction of another organ system.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Tertiary hyperparathyroidism is seen in dialysis clients who have chronic secondary hyperparathyroidism.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Prevalence
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Hyperparathyroidism is most prevalent in postmenopausal women over the age of 60.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Incidence of hyperparathyroidism is about equal in men and women under the age of 50. Incidence increases with age and female gender.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title The occurrence of hyperparathyroidism is highest among blacks followed by whites.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title The condition is less prevalent in asians, hispanics, and other races.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Characteristics/Clinical Presentation[edit | edit source]

Hyperparathyroidism effects not only the endocrine system but also the central nervous system (CNS), musculoskeletal system, gastrointestinal (GI), and the gastrourinary system (GU). Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Individuals with this disorder commonly exhibit muscle weakness and fatigue. Other symptoms associated with hyperparathyroidism include:

  •  Loss of appetite Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  LethargyCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  DrowsinessCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Weight lossCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Nausea and vomitingCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  DepressionCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Increased thirst and urination Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Kidney stonesCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Bone and joint painCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Fragile bones that easily fracture (osteoporosis)Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  GI problemsCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  PancreatitisCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Bone decalcification (hypercalcemia)Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Psychotic paranoiaCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Frequent complaints of illness with no apparent causeCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  ParesthesiasCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Hyperactive deep tendon reflexesCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Personality changesCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Muscle weakness and atrophyCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  GoutCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  MyalgiaCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Abdominal painCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  ConstipationCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Peptic ulcersCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Renal colicCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Hyper-calcemiaCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Kidney infectionsCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Renal hypertensionCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title



Associated Co-morbidities
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Patients with mild PHPT had a significantly increased risk of developing cardiovascular, cerebrovascular disease, renal dysfunction and fractures.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Additional co-morbidities include:

  • Osteogenisis Imperfecta Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  • Paget’s DiseaseCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  • Multiple myelomaCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  CarcinomaCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Vitamin D deficiencyCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Bone damageCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Hypocalcaemia Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Kidney damage Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Medications[edit | edit source]

Medications to treat hyperparathyroidism include:

Calcimimetics. Calcimimetics mimic calcium circulating in the blood and may trick the parathyroid glands into releasing less parathyroid hormone. It may be prescribed to treat primary hyperparathyroidism, particularly if surgery hasn't successfully cured the disorder or a person isn't a good candidate for surgery.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title


Hormone replacement therapy. Hormone replacement therapy (HRT) does not address the underlying causes of excess PTH but helps to prevent bone from demineralizing as a result of excess PTH in the blood. HRT is used for menopausal women or for individuals who are exhibiting signs of osteoporosis. Estrogen and progestin are commonly used in combination for this treatment option.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title


Bisphosphonates- Bisphosphonates prevents the loss of calcium from bones decreasing the risk for development of osteoporosis which is caused by hyperparathyroidism.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title


Calcitonin- Calcitonin is used in the treatment of osteoporosis.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title It binds to osteoclasts and inhibits their action, helping to prevent the breakdown of bone.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]

Diagnostic tests/Labs:

  • Blood tests are used to indicate how much calcium, PTH and phosphorus are in the blood. If an elevated amount of any of these is found in the blood it may be indicative of overactivity of the parathyroid glands.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Other tests once diagnosis has been made:

  •  Bone mineral density test (bone densitometry). Dual energy X-ray absorptiometry, or a DXA scan, is commonly used to measure bone mineral density. This test measures how many grams of calcium and other minerals are packed into a segment of bone. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Urine tests. A 24-hour collection of urine can be used to measure kidney function and how much calcium is expelled in urine. This test may help in determining if kidney dysfunction or parathyroid disorder is the primary cause of bone demineralization. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
  •  Imaging tests of kidneys. Used to determine presence of kidney stones or other kidney abnormalities.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Etiology/Causes[edit | edit source]

Primary hyperparathyroidism is often caused by an adenoma of the parathyroid gland.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title


Systemic Involvement Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title[edit | edit source]

Borders in tact.png


Medical Management (current best evidence)[edit | edit source]

Treatment for primary hyperparathyroidism is surgical removal of affected parathyroid gland, management of any bone or organ damage, and use of medication to protect bones prior to surgery or when parathyroidectomy is not an option. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Physical Therapy Management (current best evidence)[edit | edit source]

Therapists may observe skeletal, articular and neuromuscular impairments associated with hyperparathyroidism. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title In the acute phase, therapists should exercise caution with patients as they are at an increased risk for bone fracture.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title After surgery, patients should be encouraged to ambulate as soon as possible to prevent further demineralization.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Encourage and aid patients in setting up their homes to avoid or minimize fall risks.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Alternative/Holistic Management (current best evidence)[edit | edit source]

Eating a healthy and well balanced natural diet, avoiding coffee, tea, alcohol, tobacco, and carbonated beverages, exercising regularly, and drinking plenty of water may help to reduce the symptoms of hyperparathyroidism.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Some herbal supplements have been used for the treatment of hyperparathyroidism including chaste tree and dandelion.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title  Some holistic medical practitioners also treat hyperparathyroidism.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Vitamin supplements including calcium, vitamin D, Ipriflavone (soy isoflavones) standardized extract and Omega-3 fatty acids have been used to help treat this disorder.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Alternative treatments for hyperparathyroidism have not been proven effective for the management of hyperparathyroidism. Alternative/holistic treatment options should be discussed with a qualified healthcare practitioner prior to initiation.

Differential Diagnosis[edit | edit source]


Adrenal insufficiency Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title


Certain malignant tumors or myelomasCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title 


Excessive calcium or vitamin D ingestionCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title 


Familial hypocalciuric hypercalcemiaCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title 


HyperthyroidismCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title


MalnutritionCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title 

Case Reports/ Case Studies[edit | edit source]

A patient with persistent primary hyperparathyroidism due to a second ectopic adenoma.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

A 33 year old woman was diagnosed with hyperparathyroidism and treated with parathyroidectomy. Post-operatively the patient’s serum calcium and PTH levels decreased but did not normalize and continued to present with kidney stones.


Diplopia associated with hyperparathyroidism: report of a case.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

A 60 year old man presented with diplopia as well as common symptoms of hyperparathyroidism. He was diagnosed with primary hyperparathyroidism and a search for the cause of the diplopia continued. After undergoing thyroidectomy his double vision was relieved as his serum calcium levels returned to normal.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588946/pdf/yjbm00039-0061.pdf


Primary hyperparathyroidism presenting as recurrent acute pancreatitis: A case report and review of literatureCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

A 32 year old man presents with repetitive episodes of pancreatitis. Patient was treated by parathyroidectomy and recurrence of abdominal pain ceased and serum calcium levels normalized.

Resources
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add appropriate resource here

American Academy of Otolaryngology-Head and Neck Surgerys

American Association of Clinical Endocrinologists

American Association of Endocrine Surgeons

The American Society for Bone and Mineral Research

The Endocrine Society

The Paget Foundation for Paget’s Disease of Bone and Related Disorders

Recent Related Research (from Pubmed)[edit | edit source]

see tutorial on Adding PubMed Feed

Failed to load RSS feed from http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=145VRaMa7R_LRyM7gpegMSbbQy_gFrleMmi2JvbwfqEpnH9sZl|charset=UTF-8|short|max=10: Error parsing XML for RSS Failed to load RSS feed from http://www.ncbi.nlm.nih.gov/pubmed/?term=Hyperparathyroidism: Error parsing XML for RSS

References[edit | edit source]

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