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GROUP 4 PRESENTATION
objectives
Define hyperparathyroidism
Explain causes of hyperparathyroidism
Describe the pathophysiology of
hyperparathyroidism
Mention clinical manifestations of
hyperparathyroidism
Explain the medical and nursing management
Definition
Hyperthyroidism is a disorder of the parathyroid
gland.
It is referred to as excessive production of
parathyroid hormones (PTH) by the parathyroid
gland characterized by decalcification of bones
and formation of kidney stones which contains
calcium.
This disorder is characterized by high levels of
calcium ions in blood due to excessive bone
decalcification.
TYPES OF HYPERPARATHYROIDISM
Primary hyperparathyroidism
Occurs too-three times more in women than men
and children.
It is often common in people aged 60-70 years of
age
ETIOLOGY
Primary hyperparathyroidism is a result of an
abnormality of the parathyroid glands
Adenoma
(non-cancerous
growth)
on
the
parathyroid gland is the most cause.
Hyperplasia which is simply enlargement of the
Etiology contd
Malignant tumors (cancerous)
Genetics- inherited traits from parents that
cause the disorder
Secondary hyperparathyroidism
Occurs due to other conditions that lowers serum
calcium levels.
Therefore the Low levels of calcium levels
stimulates excess secretion of parathyroid gland
hormones and multiplication of the parathyroid
gland hormones in a process to composite for
the lowered calcium levels
PATHOPHYSIOLOGY OF HYPERPARATHYROIDISM
Parathyroid glands respond to low serum calcium
levels by releasing PTH. PTH increases serum calcium
levels through direct action on bone and the kidneys
and indirectly in the GIT.
PTH stimulates osteoclasts to reasorpt bone and
mobilize calcium into the blood.
In the kidneys, PTH acts to reduce calcium excretion
and stimulates synthesis of active vitamin D, which
stimulates calcium absorption in the gastrointestinal
tract
In their normal state, the glands function to keep
Pathophysiology contd
Sustained hypocalcaemia leads to cellular
replication and increased mass of the glands.
Adenomas, malignant tumors and hyperplasia
result into increased mass of the parathyroid
gland this in turn result in excess production of
the parathyroid hormone, PTH results in excess
bone decalcification.
Kidney failure result in inactivation of vitamin D
which is responsible for absorption of calcium in
the GIT, as such low calcium absorption result in
increased production of PTH which decalcifies
PRIMARY HYPERPARATHYROIDISM
In primary hyperparathyroidism, an abnormality
of the parathyroid gland causes inappropriate,
PTH production.
The cause of primary hyperparathyroidism
ordinarily is hypertrophy (hyperplasia) or a tumor
on one or more of the parathyroid gland.
such tumors occur much more frequently in
women than in men and children, mainly
because pregnancy and lactation stimulates the
parathyroid gland to secrete PTH to decalcify
calcium from the mothers bones for neonate
SECONDARY
HYPERPARATHYROIDISM
Functions of calcium
Bone mineralization
Muscle contraction
Skeletal
Cardiac
Smooth muscle
Blood clotting
Nerve impulse transmission
CLINICAL MANIFESTAIONS
Fragile bones that easily fracture
Kidney stones
Excessive urination and thirst
Abdominal pain
Tiring easily and fatigue
Depression and forgetfulness
Bone and joint pains
Frequent complaints of feeling ill without apparent cause
Nausea, vomiting and loss of appetite
constipation
Diagnosis of Hyperthyroidism
History taking
Ask for the following signs and symptoms
oWeight loss, weakness, joint pains, alterations
in neural activities such us forgetfulness and
changes in heart beat i.e. palpitations,
Blood test
Check for levels of parathyroid hormones and
calcium levels
Physical examination
Check for tenderness in bones, heart
Diagnosis contd
Urine test- for urine calcium levels and kidney
functioning
Neck ultra sound- to check for size of the glands
Magnetic resonance imaging-to check for size of the
glands
Bone density scanning-to check for osteoporosis
Normal bone
Management of
Hyperparathyroidism
MEDICAL MANAGEMENT
Calcimimetics
These are a group of drugs that mimic or act as
natural calcium in serum.
They induce negative feedback mechanism by
inhibiting
the
production
of
Parathyroid
hormones by the parathyroid glands.
SURGERY-PARATHYROIDECTOMY
Surgical procedure to remove part of the
parathyroid gland or tumors and any other
growth on the parathyroid gland.
NOTE: if all four glands are affected three
glands are removed leaving one to continue
functioning
NURSING MANAGEMENT
Hydration-provide at least 3 liters of fluids per
day to help prevent calcium accumulation in the
kidneys and formation of kidney stones
Take safety precautions to minimize risk of
injury from fall
Encourage patient to rest due to muscle and
bone weakness
Observe patient for signs of muscle, joint and
bone pain and monitor effectiveness of
analgesics
Provide comfort measures
Possible complication of
hyperparathyroidism
references
AMERICAN FAMILY PHYSICIAN-VOLUME 69,
NUMBER 2 / JANUARY 15, 2004 website.
www.aafp.org/afp
American Family Physician-Volume 72, Number 4
August 15, 2005
JOURNAL OF BONE AND MINERAL RESEARCHVolume 6, Supplement 2, 2012 Mary Ann Lie
Bert, Inc., Publishers
Brunner and suddarths textbook of medical
surgical nursing twelfth edition