Hyperparathyroidism - NYSORA
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Table of Contents

Contributors

Hyperparathyroidism

Hyperparathyroidism

Learning objectives

  • Describe hyperparathyroidism
  • Recognize the symptoms and signs of hypercalcemia, related to hyperparathyroidism
  • Anesthetic management of a patient with hyperparathyroidism

Definition and mechanisms

  • Hyperparathyroidism (HPT) is a condition in which the parathyroid glands produce too much parathyroid hormone (PTH)
  • PTH plays an important role in maintaining normal calcium homeostasis
  • The main effector sites responding directly or indirectly to PTH are the intestines, kidneys, and bone
  • HPT ultimately results in hypercalcemia

Classification

  • Primary HPT: Hyperfunction of the parathyroid glands (i.e., adenoma, carcinoma, or hyperplasia) leading to an overproduction of PTH
  • Secondary HPT: Appropriate compensatory response of the parathyroid glands to secrete more PTH in response to a condition (i.e., chronic kidney disease, vitamin D deficiency) that produces hypocalcemia
  • Tertiary HPT: Long-standing secondary HPT starts to behave like primary HPT, usually associated with advanced kidney failure
  • Ectopic HPT: Secretion of PTH by tissues other than the parathyroid glands

Signs and symptoms

The symptoms of HPT are caused by hypercalcemia:

  • Cardiovascular: Hypertension, shortened QT interval, prolonged PR interval, hypovolemia, conduction blockade
  • Neurological: Mental status changes, weakness, lethargy
  • Respiratory: Potential respiratory muscle weakness, poor clearance of secretions
  • Musculoskeletal: Muscle weakness, osteoporosis, pathological fractures, bone pains
  • Gastrointestinal: Abdominal pain, peptic ulcer, pancreatitis, nausea/vomiting, ↑ aspiration risk
  • Renal: Polyuria, polydipsia, renal stones, renal failure
  • Hematopoietic: Anemia

Risk factors

Pathophysiology

hyperparathyroidism, parathyroid hormone, PTH, calcium, vitamin D, hypercalcemia, osteoblast, osteoclast

Treatment

Management

hyperparathyroidism, management, preoperative, intraoperative, postoperative, hypercalcemia, rehydration, furosemide, bisphosphonate, etidronate, calcitonin, steroids, phosphate, hemodialysis, benzodiazepine, alprazolam, H2 antagonist, ranitidine, sodium citrate, glycopyrrolate, ECG, alfacalcidol, hypocalcemia

Suggested reading

  • Malhotra S, Sodhi V. Anaesthesia for thyroid and parathyroid surgery. Continuing Education in Anaesthesia Critical Care & Pain. 2007;7(2):55-58.

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