HYPERPARATHYROIDISM

JACQUELYN ROBERTS
MARCH 2019
NR507 ADVANCED PATHOPHYSIOLOGY
2 THE PARATHYROID

Regulates Parathyroid Hormone &

Blood Calcium levels
▹ PTH seeks to restores blood calcium
homeostasis
▹ Secretes PTH in response to low
circulating calcium causing bones to
release calcium stores
▹ Decreased production of PTH in response
to elevated circulating calcium
3 HYPERPARATHYROIDISM

PRIMARY HYPERPARATHYROIDSM
▹ Most common form
▹ Causes include benign tumors, familial hyperparathyroidism,
or multiple endocrine neoplasia

SECONDARY HYPERPARATHYROIDSM
▹ Resistance to parathyroid hormone or calcium
deficiencies
▹ Causes include Vitamin D deficiency, kidney
failure, malabsorption disorders (McCoy, 2018)
4 MECHANISMS OF ACTION
OVERACTIVE PARATHYROID
GLAND
▹ Parathyroid hormone
regulate calcium levels in
blood and tissues
▹ Increased release of
parathyroid hormone results
in hypercalcemia
SYMPTOMS
▹ Related to altered circulating
blood calcium
▹ Abdominal pain, loss of appetite,
headache, nausea, vomiting,
fatigue, memory loss, seizures,
etc.
5
RISK FACTORS
Increase in parathyroid hormone resulting in
excessively high levels of PTH and
hypercalcemia (McCoy, 2018)
 >50 years of age
 Post-menopausal
 Radiation or Lithium treatment
 Malabsorption disorders
 Inadequate vitamin D & Calcium intake
 Familial parathyroid hyperplasia
6 DISEASE PROGRESSION
Primary Secondary
Hyperparathyroidism Hyperparathyroidism
▹ Elevated PTH ▹ Chronic hypocalcemia
Issues with PT gland that Caused by other comorbidities
cause excess secretion of that result in chronic
PTH signal the bones and hypocalcemia resulting in
intestines to release overuse of the parathyroid in
calcium, resulting in an effort to restore
hypercalcemia homeostasis.
 ROLE OF HEALTHCARE
7 PROVIDER
Educate patients on preventative measures
▹ Dietary intake – Calcium, Vitamin D (McCoy, 2018)
▹ Adequate fluid intake – water to prevent kidney stones
▹ Exercise – regular exercise maintains strong bones
▹ Avoidance – smoking, and calcium raising drugs
Recognize early signs and symptoms and abnormal
lab values during examination
 Hypercalcemia (Schub, & Schub, 2018)
 Decreased Vitamin D
 High levels of parathyroid hormone
 TISSUE, ORGAN, SYSTEM
2 CHANGES
Enlarged glands OR chronic hypocalcemia
▹ Overproduction of PTH
Excess parathyroid hormone
▹ Mobilize calcium from bones
▹ Synthesize calcitriol
▹ Absorb calcium from intestine
▹ Increase renal calcium reabsorption (McCance &
Huether, 2019).

…All resulting in hypercalcemia

9 SIGNS & SYMPTOMS

Hypercalcemia: >10.5mg/dL
Central Nervous System changes
▹ Loss of Cell Membrane Excitability
▹ Fatigue, weakness, mild depression,
lethargy, nausea, mild concentration
or memory issues, and confusion
(Gratian, Hyland, & Scheri, 2014)
10 SIGNS & SYMPTOMS cont.

Renal Function
▹ Impaired function
▹ Calcium stones
Cardiac Function
▹ Arrhythmias
▹ Calcification of Myocardium
and or valves
Bone Pain
▹ Depletion of calcium
11 DIAGNOSIS
BLOOD TESTS
▹ Calcium concentrations with inappropriately
elevated parathyroid hormone (Rudin,
McKenzie, Wermer, Thompson, & Lyden, 2019)
▹ Vitamin D (secondary hyperparathyroidism)
DEXA SCAN
▹ Bone mineral density (Mayo Clinic, 2019)
24-HOUR URINE COLLECTION
▹ Kidney Function (Creatinine)
12 INTERVENTIONS

Primary Hyperparathyroidism
▹ Parathyroidectomy (Rudin,
McKenzie, Wermer, Thompson, &
Lyden, 2019),

Secondary Hyperparathyroidism
▹ Identify and treat underlying cause of
chronic hypocalcemia
▹ Vitamin D, Calcitriol, phosphate
binding supplements
13 IN CONCLUSION

Hyperparathyroidism
 Primary or Secondary HPT
 Elevated PTH and subsequent hypercalcemia
 Reduced quality of life r/t signs and symptoms
(Dalemo, Eggertsen, Hjerpe, Jansson, & Boström, K. B.
(2014).
 Diagnosed by blood test, DEXA scan, and
urinalysis
 Treatment includes parathyroidectomy (primary
HPT) and tailored treatment (secondary HPT)
14 IN CONCLUSION

Nurse Practitioner
 Careful observation of lab values
 Signs and Symptoms
 Disease Management
 Patient Education
15 REFERENCES
Dalemo, S., Eggertsen, R., Hjerpe, P., Jansson, S., & Boström, K. B. (2014). Quality of life and
health care consumption in primary care patients with elevated serum calcium
concentrations in - a prospective, case control, study. BMC Family Practice, 15, 84.
https://doi-org.chamberlainuniversity.idm.oclc.org/10.1186/1471-2296-15-84
Gratian, L. F., Hyland, K. A., & Scheri, R. P. (2014). Hyperparathyroid crisis due to
asymmetric parathyroid hyperplasia with a massive ectopic parathyroid gland. Endocrine
Practice: Official Journal Of The American College Of Endocrinology And The American
Association Of Clinical Endocrinologists, 20(10), e180–e182. https://doi-
org.chamberlainuniversity.idm.oclc.org/10.4158/EP14136.CR
Hyperparathyroidism. Mayo Clinic. https://www.mayoclinic.org/diseases-
conditions/hyperparathyroidism/diagnosis-treatment/drc-20356199. Published March 13,
2019. Accessed April 6, 2019.
16 REFERENCES cont.
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in
adults and children (8th ed.). St. Louis, MO: Elsevier.
McCoy, K. (2018). Hyperparathyroidism. Health Library: Evidence-Based Information.
Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=htt
ps://search.ebscohost.com/login.aspx?direct=true&db=nup&AN=2009867195&site=eds-
live&scope=site
Rudin, A. V., McKenzie, T. J., Wermer, R. A., Thompson, G. B., & Lyden, M. L. (2019). Primary
Hyperparathyroidism: Redefining Cure. The American Surgeon, 85(2), 214–218. Retrieved
from https://search-ebscohost-
com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=mdc&AN=30819301
&site=eds-live&scope=site
17 REFERENCES
Schub, T. B., & Schub, E. R. B. (2018). Hypercalcemia and Hyperparathyroidism. CINAHL
Nursing Guide. Retrieved from
https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.asp
x?direct=true&b=n up&AN=T702298&site=eds-live&scope=site