GLANDULA PARATIROID

Calcium Regulation
HIPERPARATIROID PRIMER

In patients with primary

hyperparathyroidism, serum PTH
Primary hyperparathyroidism is one
levels are inappropriately elevated
of the most common endocrine
for the level of serum calcium,
disorders, and it is an important
whereas PTH levels are low to
cause of hypercalcemia.
undetectable in hypercalcemia
because of nonparathyroid disease

The frequency of the various

parathyroid lesions underlying the
hyperfunction is as follows:
• Adenoma 75-80%
• Primary hyperplasia (diffuse or nodular)
10-15%
• Parathyroid carcinoma < 5%
Primary hyperparathyroidism is
usually a disease of adults and is
more common in women than in
men by a ratio of nearly 3:1.
The signs and symptoms of hyperparathyroidism reflect the combined effects of increased PTH
secretion and hypercalcemia.
Primary hyperparathyroidism has been traditionally associated with a constellation of symptoms
that included "painful bones, renal stones, abdominal groans, and psychic moans".

• Bone disease includes bone pain

secondary to fractures of bones
weakened by osteoporosis or osteitis
fibrosa cystica.
• Nephrolithiasis (renal stones) occurs
in 20% of newly diagnosed patients,
with attendant pain and obstructive
uropathy. Chronic renal insufficiency
and a variety of abnormalities in renal
function are found, including polyuria
and secondary polydipsia.
• Gastrointestinal disturbances
include constipation, nausea, peptic
ulcers, pancreatitis, and gallstones.
• Central nervous system alterations
include depression, lethargy, and
eventually seizures.
• Neuromuscular abnormalities
include complaints of weakness and
fatigue.
• Cardiac manifestations include
aortic or mitral valve calcifications (or
both).
HIPERPARATIROID SEKUNDER

Caused by any condition associated with

a chronic depression in the serum
calcium level because low serum
calcium leads to compensatory
overactivity of the parathyroid
glands.

Renal failure is by far the most

common cause of secondary
hyperparathyroidism although a number
of other diseases, including inadequate
dietary intake of calcium, steatorrhea,
and vitamin D deficiency, may also
cause this disorder.
 HIPOPARATIROID
PTH deficiency results in hypocalcemia

- Primary hypoparathyroid: inadequate

PTH activity
Low PTH with a concomitant low
calcium level

- Secondary hypoparathyroid: a
physiologic state in which PTH levels
are low in response to a primary
process that causes hypercalcemia
Low PTH and serum calcium level is
elevated

- Pseudohypoparathyroidism: A rare
familial disorders with target tissue
resistance to PTH. PTH concentration is
elevated as a result of resistance to
PTH caused by mutations in the PTH
receptor system
MANIFESTASI KLINIS HIPOPARATIROID

The hallmark of hypocalcemia is tetany, which is

characterized by neuromuscular irritability, resulting
from decreased serum ionized calcium concentration.

These findings can range from circumoral numbness or

paresthesias (tingling) of the distal extremities and to
life-threatening laryngospasm and generalized
seizures.

The classic findings on physical examination of

patients with neuromuscular irritability
are Chvostek sign and Trousseau sign.
Mental status changes can include emotional instability, anxiety and depression, confusional
states, hallucinations, and frank psychosis.

Intracranial manifestations include calcifications of the basal ganglia, parkinsonian-like

movement disorders, and increased intracranial pressure with resultant papilledema.

Ocular disease results in calcification of the lens leading to cataract formation.

Cardiovascular manifestations include a conduction defect, which produces a characteristic

prolongation of the QT interval in the electrocardiogram.

Dental abnormalities occur when hypocalcemia is present during early development. These
findings are highly characteristic of hypoparathyroidism and include dental hypoplasia,
failure of eruption, defective enamel and root formation, and abraded carious teeth.
TATALAKSANA HIPOPARATIROID
The mainstay of treatment is a
combination of oral calcium with
pharmacological doses of vitamin
D or its potent analogues.
Phosphate restriction in diet may
also be useful with or without
aluminum hydroxide gel to lower
serum phosphate level.
Emergency Tetany
Calcium should be given
parenterally till adequate
serum calcium level is
obtained and then vitamin D
supplementation with oral
calcium should be initiated.
 EKG PADA HIPER/HIPOKALSEMIA
Hipokalsemia Hiperkalsemia
Pemanjangan QT interval
Normal
Pemendekan QT interval