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<div class="noeditbox">Welcome to [[Pathophysiology of Complex Patient Problems|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!!</div><div class="editorbox">
 
'''Original Editors '''- Suzette Austin &amp; Erica Jezke&nbsp;[[Pathophysiology of Complex Patient Problems|from Bellarmine University's&nbsp;Pathophysiology of Complex Patient Problems project.]]  
'''Original Editors '''- Suzette Austin &amp; Erica Jezke&nbsp;[[Pathophysiology of Complex Patient Problems|from Bellarmine University's&nbsp;Pathophysiology of Complex Patient Problems project.]]  


'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} &nbsp;  
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} &nbsp;  
</div>
== Definition/Description<br>  ==
== Introduction ==
 
[[File:Parathyroid.png|thumb|Parathyroid in colour]]
Hyperparathyroidism is a disorder caused by oversecretion of parathyroid hormone (PTH) by one or more of the four parathyroid glands.<ref name="1" /> This disorder can disrupt calcium, phosphate, and bone metabolism. <ref name="1">Goodman C, Fuller K.. Pathology: Implications for the Physical Therapist, 3rd ed. St. Louis, Missouri: Saunders Elsevir; 2007.</ref>The parathyroid glands are located in the neck on the posterior surface of each lobe of the thyroid gland.&nbsp;<ref name="2" /><ref name="3" /> Each of the four parathyroid glands is about the size of a grain of rice.<ref name="3">Mayo Clinic Staff. Diseases-conditions/hyperparathyroidism/basics/symptoms. http://www.mayoclinic.org (accessed January 16, 2014).</ref> As part of the endocrine system, these glands secrete parathyroid hormone (PTH), which regulates calcium and phosphorus.&nbsp;<sup><ref name="2">Goodman C, Snyder T. Differential Diagnosis for Physical Therapists: Screening for Referral, 5th ed. St. Louis, Missouri: Saunders Elsevir; 2013.</ref> </sup>Hyperparathyroidism is classified into three groups: primary, secondary, or tertiary.<ref name="1" />&nbsp;  
Hyperparathyroidism is a disorder caused by oversecretion of parathyroid hormone (PTH) by one or more of the four parathyroid glands.<ref name="p1" /> This disorder can disrupt calcium, phosphate, and bone metabolism. <ref name="p1">Goodman C, Fuller K.. Pathology: Implications for the Physical Therapist, 3rd ed. St. Louis, Missouri: Saunders Elsevir; 2007.</ref>The parathyroid glands are located in the neck on the posterior surface of each lobe of the thyroid gland.&nbsp;<ref name="p2" /><ref name="p3" /> Each of the four parathyroid glands is about the size of a grain of rice.<ref name="p3">Mayo Clinic Staff. Diseases-conditions/hyperparathyroidism/basics/symptoms. http://www.mayoclinic.org (accessed January 16, 2014).</ref> As part of the endocrine system, these glands secrete parathyroid hormone (PTH), which regulates calcium and phosphorus.&nbsp;<sup><ref name="p2">Goodman C, Snyder T. Differential Diagnosis for Physical Therapists: Screening for Referral, 5th ed. St. Louis, Missouri: Saunders Elsevir; 2013.</ref> </sup>&nbsp;
 
Primary hyperparathyroidism develops when there is an imbalance between serum calcium levels and PTH secretion.<ref name="1" /><br> Secondary hyperparathyroidism occurs when the glands have become enlarged due to malfunction of another organ system.<ref name="1" />
 
Tertiary hyperparathyroidism is seen in dialysis clients who have chronic secondary hyperparathyroidism.<ref name="1" /> <br>
 
<br>
 
Hyperparathyroid Images:


[http://www.riversideonline.com/source/images/image_popup/pthyroid.jpg www.riversideonline.com/source/images/image_popup/pthyroid.jpg]
Even though the word “parathyroid” has the word “thyroid” in it, hyperparathyroidism has nothing to do with the [[Thyroid Gland|thyroid gland]], or with [[hypothyroidism]] or [[hyperthyroidism]].


[http://images.medicinenet.com/images/illustrations/parathyroid_glands.jpg images.medicinenet.com/images/illustrations/parathyroid_glands.jpg]
Watch this 5 minute video{{#ev:youtube|sD9st1ZPFrQ}}
== Types ==
[[File:Thyroid parathyroid.jpeg|thumb|Thyroid and parathyroid]]Hyperparathyroidism is classified into three groups: primary, secondary, or tertiary.<ref name="p1" />&nbsp;


[http://surgery.med.umich.edu/general/endocrine/images/content/parathyroid.jpg surgery.med.umich.edu/general/endocrine/images/content/parathyroid.jpg]
# Primary hyperparathyroidism (most common type):a problem in which the parathyroid gland is releasing too much PTH, even though there is enough calcium already in the blood. Most of the time, this is caused by an adenoma (a non-malignant growth) of the parathyroid gland.<ref name=":0">Very well health Hyperparathyroidism Available:https://www.verywellhealth.com/hyperparathyroidism-symptoms-causes-diagnosis-and-treatment-4688580 (accessed 3.4.20220</ref>
# Secondary hyperparathyroidism occurs when the glands have become enlarged due to malfunction of another organ system.<ref name="p1" /> Causes of secondary hyperparathyroidism include; severe [[Vitamin D Deficiency|deficiency in vitamin D,]] [[Vitamin C Deficiency (Scurvy)|severe deficiency in calcium]], and [[Chronic Kidney Disease|chronic renal failure]]. Chronic renal failure is the most common cause of secondary hyperparathyroidism.<ref name="suz">Mayo Clinic Staff. Diseases/conditions/hyperparathyroidism/basics/causes/ http://www.mayoclinic.org (accessed January 16, 2014)</ref>&nbsp;
# Tertiary hyperparathyroidism is seen in [[Dialysis Case Study|dialysis]] clients who have chronic secondary hyperparathyroidism.<ref name="p1" />&nbsp; Dialysis clients who suffer from chronic renal failure lack the ability to absorb and convert vitamin D into a form that can be used by the body. This decline in vitamin D decreases the amount of calcium that can be absorbed.<ref name="suz" /><br>


== Prevalence<br> ==
== Epidemiology ==
Hyperparathyroidism may be a problem for roughly two or three women in 1,000, and primarily affects women over the age of 65. It is most common in post-menopausal women, but it can occur in males and females of any age.<ref name=":0" />  


Hyperparathyroidism is most prevalent in postmenopausal women over the age of 60.<ref name="1" /> Incidence of hyperparathyroidism is about equal in men and women under the age of 50. Incidence increases with age and female gender.<ref name="4">Yeh M, Ituarte P, Adams A, et al. . Incidence and prevalence of primary hyperparathyroidism in a racially mixed population.. The Journal Of Clinical Endocrinology And Metabolism 2013; (98(3)): 1122-1129.</ref> The occurrence of hyperparathyroidism is highest among blacks followed by whites.<ref name="4" /> The condition is less prevalent in asians, hispanics, and other races.<ref name="4" /><br>
Most cases (80%) of hyperparthyroidism are discovered accidental during routine blood tests.<ref name="Skugor">Skugor, M. Milas, M. Hypercalcemia [Internet].Accessed 2014 Apr 3. Available from: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/hypercalcemia/</ref>  


== Characteristics/Clinical Presentation  ==
== Characteristics/Clinical Presentation  ==


Hyperparathyroidism effects not only the endocrine system but also the central nervous system (CNS), musculoskeletal system, gastrointestinal (GI), and the gastrourinary system (GU).&nbsp;<ref name="2" />
Hyperparathyroidism is supported biochemically by either an elevated serum parathyroid hormone level or an inappropriately normal level in the setting of [[Hypercalcemia|hypercalcaemia]].  
 
Individuals with this disorder commonly exhibit muscle weakness and fatigue. Other symptoms associated with hyperparathyroidism include:
 
*&nbsp;Loss of appetite&nbsp;<ref name="2" />
*&nbsp;Lethargy<ref name="1" />
*&nbsp;Drowsiness<ref name="1" />
*&nbsp;Weight loss<ref name="2" />
*&nbsp;Nausea and vomiting<ref name="2" />
*&nbsp;Depression<ref name="2" />
*&nbsp;Increased thirst and urination&nbsp;<ref name="2" />
*&nbsp;Kidney stones<ref name="3" />
*&nbsp;Bone and joint pain<ref name="3" />
*&nbsp;Fragile bones that easily fracture (osteoporosis)<ref name="3" />
*&nbsp;GI problems<ref name="2" />
*&nbsp;Pancreatitis<ref name="2" />
*&nbsp;Bone decalcification (hypercalcemia)<ref name="2" />
*&nbsp;Psychotic paranoia<ref name="2" />
*&nbsp;Frequent complaints of illness with no apparent cause<ref name="3" />
*&nbsp;Paresthesias<ref name="1" />
*&nbsp;Hyperactive deep tendon reflexes<ref name="1" />
*&nbsp;Personality changes<ref name="1" />
*&nbsp;Muscle weakness and atrophy<ref name="1" />
*&nbsp;Gout<ref name="1" />
*&nbsp;Myalgia<ref name="1" />
*&nbsp;Abdominal pain<ref name="1" />
*&nbsp;Constipation<ref name="1" />
*&nbsp;Peptic ulcers<ref name="1" />
*&nbsp;Renal colic<ref name="1" />
*&nbsp;Hyper-calcemia<ref name="1" />
*&nbsp;Kidney infections<ref name="1" />
*&nbsp;Renal hypertension<ref name="1" />
 
<br><br>
 
== Associated Co-morbidities<br>  ==
 
Patients with mild PHPT had a significantly increased risk of developing cardiovascular, cerebrovascular disease, renal dysfunction and fractures.<ref name="4" /> Additional co-morbidities include:
 
*Osteogenisis Imperfecta&nbsp;<ref name="1" />
*Paget’s Disease<ref name="1" />
*Multiple myeloma<ref name="1" />
*&nbsp;Carcinoma<ref name="1" />
*&nbsp;Vitamin D deficiency<ref name="1" />
*&nbsp;Bone damage<ref name="1" />
*&nbsp;Hypocalcaemia <ref name="1" />
*&nbsp;Kidney damage <ref name="4">Ning Y, Donnan P, Leese G, et al.. Increased mortality and morbidity in mild primary hyperparathyroid patients. . The Parathyroid Epidemiology and Audit Research Study (PEARS). Clinical Endocrinology 2010; (73(1)): 30-34.</ref><br>
 
== Medications  ==
 
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.<ref name="5">Mayo Clinic Staff. Diseases-conditions/hyperparathyroidism/treatment. http://www.mayoclinic.org (accessed January 16, 2014).</ref>
 
<br> 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.<ref name="5" />
 
<br> Bisphosphonates- Bisphosphonates prevents the loss of calcium from bones decreasing the risk for development of osteoporosis which is caused by hyperparathyroidism.<ref name="5" />
 
<br> Calcitonin- Calcitonin is used in the treatment of osteoporosis.<ref name="6">Gladson B. Pharmacology for Rehabilitation Professionals, 2nd ed. St. Louis: Elseivier Saunders; 2011.</ref> It binds to osteoclasts and inhibits their action, helping to prevent the breakdown of bone.<ref name="6" /> <br>
 
== Diagnostic Tests/Lab Tests/Lab Values  ==
 
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.<ref name="5" />
 
Other tests once diagnosis has been made:
 
*&nbsp;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. <ref name="5" />
*&nbsp;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. <ref name="5" />
*&nbsp;Imaging tests of kidneys. Used to determine presence of kidney stones or other kidney abnormalities.<ref name="5" /><br>
 
<br>
 
Images:
 
[http://www.tappmedical.com/page_images/absorptiometry.jpg Dual energy X-ray absorptiometry]
 
[http://www.kidneystonestreatment.co/image-files/kidney-stone-ivp.jpg Kidney Stone Imaging]  
 
[http://www.radiologyinfo.org/photocat/popup/ct-kidney-stones.jpg Kidney Stone X-ray]
 
== Etiology/Causes  ==
 
Primary hyperparathyroidism is often caused by an adenoma of the parathyroid gland.<ref name="1" /> <br> <br> <br> {{#ev:youtube|sD9st1ZPFrQ}}
 
== Systemic Involvement <ref name="2" />  ==


[[Image:Borders_in_tact.png]]<br>
Most people don’t experience any direct symptoms from their hyperparathyroidism. However, sometimes it may cause symptoms like the following: Fatigue; Weakness; Anxiety or depression; Lack of appetite; Abdominal pain; Nausea and vomiting; Constipation; Excessive thirst; Bone pain; Heart rhythm problems (rarely).  


<br>
Symptoms may also occur from the complications of hyperparathyroidism. For example, hyperparathyroidism puts one at an increased risk of bone breaks, due to worsened osteoporosis. It also increases the chance of having kidney stones.<ref name=":0" />
== Diagnosis ==
May include: Blood tests to check for calcium, phosphorus, magnesium and PTH levels; bone x-rays; kidney scans; biopsy.
== Medical Management ==
[[File:Parathyroid adenoma.png|thumb|Parathyroid adenoma]]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.&nbsp;<ref name="p1" />


== Medical Management (current best evidence)  ==
The treatment for secondary hyperparathyroidism will vary based on its cause.


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.&nbsp;<ref name="1" />  
* If  secondary hyperparathyroidism is related to kidney disease a eg nephrologist may recommend: tic use, which mimics calcium circulating in the blood and may trick the parathyroid glands into releasing less parathyroid hormone; limit  protein intake and take calcium supplements<ref name="p5">Mayo Clinic Staff. Diseases-conditions/hyperparathyroidism/treatment. http://www.mayoclinic.org (accessed January 16, 2014).</ref>.
* Other causes of secondary hyperparathyroidism require different treatments. eg, avoid foods containing gluten if  secondary hyperparathyroidism is from from celiac disease; take vitamin D supplements if secondary hyperparathyroidism is from a vitamin D deficiency<ref name=":0" />.


Surgical Images:<br>
== Physical Therapy Management ==


[http://endocrinesurgery.ucla.edu/images/mip_skin_incision_lg.jpg Skin incision]
Therapists may observe skeletal, articular and neuromuscular impairments associated with hyperparathyroidism.&nbsp;<ref name="p1" /><ref name="p3" />


[http://endocrinesurgery.ucla.edu/images/mip_parathyroid_adenoma_lrg.jpg Adenoma]
* In the acute phase, therapists should exercise caution with patients as they are at an increased risk for bone fracture.<ref name="p1" />  
 
* After surgery, patients should be encouraged to ambulate as soon as possible to prevent further demineralization.<ref name="p1" />  
== Physical Therapy Management (current best evidence)  ==
* Encourage and aid patients in setting up their homes to avoid or minimise [[Falls Risk Assessment Tool (FRAT): An Overview to Assist Understanding and Conduction|fall risks]].<ref name="p1" />
 
Therapists may observe skeletal, articular and neuromuscular impairments associated with hyperparathyroidism.&nbsp;<ref name="1" /><ref name="3" /> In the acute phase, therapists should exercise caution with patients as they are at an increased risk for bone fracture.<ref name="1" /> After surgery, patients should be encouraged to ambulate as soon as possible to prevent further demineralization.<ref name="1" /> Encourage and aid patients in setting up their homes to avoid or minimize fall risks.<ref name="1" />
 
== Alternative/Holistic Management (current best evidence) ==
 
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.<ref name="7">(2013) Hyperparathyroisism, Available at: http://umm.edu/health/medical/altmed/condition/hyperparathyroidism (Accessed: January 17, 2014.)</ref> Some herbal supplements have been used for the treatment of hyperparathyroidism including chaste tree and dandelion.<ref name="7" />&nbsp; Some holistic medical practitioners also treat hyperparathyroidism.<ref name="7" /> Vitamin supplements including calcium, vitamin D, Ipriflavone (soy isoflavones) standardized extract and Omega-3 fatty acids have been used to help treat this disorder.<ref name="7" /> 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  ==
 
<br>[http://www.physio-pedia.com/Addison%27s_Disease Adrenal insufficiency] <ref name="8">Hyperparathyroidism: differential diagnosis, Available at: http://www.google.com/url?q=http%3A%2F%2Fwww.mdguidelines.com%2Fhyperparathyroidism%2Fdifferential-diagnosis&amp;amp;sa=D&amp;amp;sntz=1&amp;amp;usg=AFQjCNH8A5bwzEOzyVFe_WOquB5mwXbrsQ (Accessed: 16th January 2014)</ref><br>
 
<br>
 
Certain malignant tumors or [http://www.physio-pedia.com/Multiple_Myeloma myelomas]<ref name="8" />&nbsp;
 
<br>
 
Excessive calcium or vitamin D ingestion<ref name="8" />&nbsp;
 
<br>
 
Familial hypocalciuric [http://www.physio-pedia.com/Hypercalcemia hypercalcemia]<ref name="8" />&nbsp;
 
<br>
 
[http://www.physio-pedia.com/Hyperthyroidism Hyperthyroidism]<ref name="8" />
 
<br> Malnutrition<ref name="8" />&nbsp;


== Case Reports/ Case Studies  ==
== Case Reports/ Case Studies  ==


[http://www.nature.com/nrendo/journal/v3/n3/full/ncpendmet0448.html A patient with persistent primary hyperparathyroidism due to a second ectopic adenoma].<ref name="9">Hamdy N. A patient with persistent primary hyperparathyroidism due to a second ectopic adenoma. Natural Clinical Practice Endocrinology and Metabolism. [Serial on the Internet].2007 [cited 2014 Jan. 17];3:311-315. Available from:fckLRhttp://www.nature.com/nrendo/journal/v3/n3/full/ncpendmet0448.html</ref>  
# [http://www.nature.com/nrendo/journal/v3/n3/full/ncpendmet0448.html A patient with persistent primary hyperparathyroidism due to a second ectopic adenoma].<ref name="p9">Hamdy N. A patient with persistent primary hyperparathyroidism due to a second ectopic adenoma. Natural Clinical Practice Endocrinology and Metabolism. [Serial on the Internet].2007 [cited 2014 Jan. 17];3:311-315. Available from:fckLRhttp://www.nature.com/nrendo/journal/v3/n3/full/ncpendmet0448.html</ref> 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.
 
# [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588946/pdf/yjbm00039-0061.pdf Diplopia associated with hyperparathyroidism: report of a case].<ref name="p0">Forman B.H., Ciardiello K., Landau S.J., Freedman J.K. (1995) 'Diplopia associated with hyperparathyroidism: report of a case', Yale J Biol Med, 68(5-6), pp. 215-217 [Online]. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588946/ (Accessed: 17th January 2014).</ref> 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 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.  
# [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079873/ Primary hyperparathyroidism presenting as recurrent acute pancreatitis: A case report and review of literature]<ref name="p1" /> 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>[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588946/pdf/yjbm00039-0061.pdf Diplopia associated with hyperparathyroidism: report of a case].<ref name="10">Forman B.H., Ciardiello K., Landau S.J., Freedman J.K. (1995) 'Diplopia associated with hyperparathyroidism: report of a case', Yale J Biol Med, 68(5-6), pp. 215-217 [Online]. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588946/ (Accessed: 17th January 2014).</ref>  
 
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>
 
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079873/ 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;amp;amp;amp;amp;amp;amp;sa=D&amp;amp;amp;amp;amp;amp;amp;amp;sntz=1&amp;amp;amp;amp;amp;amp;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>
 
== Resources <br>  ==
 
add appropriate resource here<br>
 
[http://www.entnet.org/ American Academy of Otolaryngology-Head and Neck Surgerys]
 
[http://www.google.com/url?q=http%3A%2F%2Fwww.aace.com&sa=D&sntz=1&usg=AFQjCNGrLfIroKahuSBkJ8UpnSkM8Li-ew American Association of Clinical Endocrinologists]<br>
 
[http://www.google.com/url?q=http%3A%2F%2Fwww.endocrinesurgery.org&sa=D&sntz=1&usg=AFQjCNGdXHi9LXkZUA9OgJC-tl4tD14CNg American Association of Endocrine Surgeons]<br>
 
[http://www.google.com/url?q=http%3A%2F%2Fwww2.niddk.nih.gov%2FFooter%2FDisclaimer&sa=D&sntz=1&usg=AFQjCNE7s-Mo9GS_MU8c5papbkY5NaoQyg The American Society for Bone and Mineral Research]<br>
 
[http://www.endocrine.org/ The Endocrine Society] <br>
 
[http://www.google.com/url?q=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2588946%2F&sa=D&sntz=1&usg=AFQjCNH_zlnObj9RndvNE0qPriF54vBj7Q The Paget Foundation for Paget’s Disease of Bone and Related Disorders]<br>
 
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
 
see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]]
<div class="researchbox">
<rss>http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=12QQbiNmM99cUQH-U_2kROPzG3mfEeEABFRSb_CoV6avQ9wED9|charset=UTF-8|short|max=10</rss>&nbsp;<rss>http://www.ncbi.nlm.nih.gov/pubmed/?term=Hyperparathyroidism</rss>
</div>


== References  ==
== References  ==


<references />  
<references />
 
[[Category:Endocrine_Metabolic|Endocrine_Metabolic]]

Latest revision as of 02:50, 3 April 2022

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  

Introduction[edit | edit source]

Parathyroid in colour

Hyperparathyroidism is a disorder caused by oversecretion of parathyroid hormone (PTH) by one or more of the four parathyroid glands.[1] This disorder can disrupt calcium, phosphate, and bone metabolism. [1]The parathyroid glands are located in the neck on the posterior surface of each lobe of the thyroid gland. [2][3] Each of the four parathyroid glands is about the size of a grain of rice.[3] As part of the endocrine system, these glands secrete parathyroid hormone (PTH), which regulates calcium and phosphorus. [2]  

Even though the word “parathyroid” has the word “thyroid” in it, hyperparathyroidism has nothing to do with the thyroid gland, or with hypothyroidism or hyperthyroidism.

Watch this 5 minute video

Types[edit | edit source]

Thyroid and parathyroid

Hyperparathyroidism is classified into three groups: primary, secondary, or tertiary.[1] 

  1. Primary hyperparathyroidism (most common type):a problem in which the parathyroid gland is releasing too much PTH, even though there is enough calcium already in the blood. Most of the time, this is caused by an adenoma (a non-malignant growth) of the parathyroid gland.[4]
  2. Secondary hyperparathyroidism occurs when the glands have become enlarged due to malfunction of another organ system.[1] Causes of secondary hyperparathyroidism include; severe deficiency in vitamin D, severe deficiency in calcium, and chronic renal failure. Chronic renal failure is the most common cause of secondary hyperparathyroidism.[5] 
  3. Tertiary hyperparathyroidism is seen in dialysis clients who have chronic secondary hyperparathyroidism.[1]  Dialysis clients who suffer from chronic renal failure lack the ability to absorb and convert vitamin D into a form that can be used by the body. This decline in vitamin D decreases the amount of calcium that can be absorbed.[5]

Epidemiology[edit | edit source]

Hyperparathyroidism may be a problem for roughly two or three women in 1,000, and primarily affects women over the age of 65. It is most common in post-menopausal women, but it can occur in males and females of any age.[4]

Most cases (80%) of hyperparthyroidism are discovered accidental during routine blood tests.[6]

Characteristics/Clinical Presentation[edit | edit source]

Hyperparathyroidism is supported biochemically by either an elevated serum parathyroid hormone level or an inappropriately normal level in the setting of hypercalcaemia.

Most people don’t experience any direct symptoms from their hyperparathyroidism. However, sometimes it may cause symptoms like the following: Fatigue; Weakness; Anxiety or depression; Lack of appetite; Abdominal pain; Nausea and vomiting; Constipation; Excessive thirst; Bone pain; Heart rhythm problems (rarely).

Symptoms may also occur from the complications of hyperparathyroidism. For example, hyperparathyroidism puts one at an increased risk of bone breaks, due to worsened osteoporosis. It also increases the chance of having kidney stones.[4]

Diagnosis[edit | edit source]

May include: Blood tests to check for calcium, phosphorus, magnesium and PTH levels; bone x-rays; kidney scans; biopsy.

Medical Management[edit | edit source]

Parathyroid adenoma

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. [1]

The treatment for secondary hyperparathyroidism will vary based on its cause.

  • If secondary hyperparathyroidism is related to kidney disease a eg nephrologist may recommend: tic use, which mimics calcium circulating in the blood and may trick the parathyroid glands into releasing less parathyroid hormone; limit protein intake and take calcium supplements[7].
  • Other causes of secondary hyperparathyroidism require different treatments. eg, avoid foods containing gluten if secondary hyperparathyroidism is from from celiac disease; take vitamin D supplements if secondary hyperparathyroidism is from a vitamin D deficiency[4].

Physical Therapy Management[edit | edit source]

Therapists may observe skeletal, articular and neuromuscular impairments associated with hyperparathyroidism. [1][3]

  • In the acute phase, therapists should exercise caution with patients as they are at an increased risk for bone fracture.[1]
  • After surgery, patients should be encouraged to ambulate as soon as possible to prevent further demineralization.[1]
  • Encourage and aid patients in setting up their homes to avoid or minimise fall risks.[1]

Case Reports/ Case Studies[edit | edit source]

  1. A patient with persistent primary hyperparathyroidism due to a second ectopic adenoma.[8] 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.
  2. Diplopia associated with hyperparathyroidism: report of a case.[9] 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.
  3. Primary hyperparathyroidism presenting as recurrent acute pancreatitis: A case report and review of literature[1] 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.

References[edit | edit source]

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Goodman C, Fuller K.. Pathology: Implications for the Physical Therapist, 3rd ed. St. Louis, Missouri: Saunders Elsevir; 2007.
  2. ↑ 2.0 2.1 Goodman C, Snyder T. Differential Diagnosis for Physical Therapists: Screening for Referral, 5th ed. St. Louis, Missouri: Saunders Elsevir; 2013.
  3. ↑ 3.0 3.1 3.2 Mayo Clinic Staff. Diseases-conditions/hyperparathyroidism/basics/symptoms. http://www.mayoclinic.org (accessed January 16, 2014).
  4. ↑ 4.0 4.1 4.2 4.3 Very well health Hyperparathyroidism Available:https://www.verywellhealth.com/hyperparathyroidism-symptoms-causes-diagnosis-and-treatment-4688580 (accessed 3.4.20220
  5. ↑ 5.0 5.1 Mayo Clinic Staff. Diseases/conditions/hyperparathyroidism/basics/causes/ http://www.mayoclinic.org (accessed January 16, 2014)
  6. ↑ Skugor, M. Milas, M. Hypercalcemia [Internet].Accessed 2014 Apr 3. Available from: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/hypercalcemia/
  7. ↑ Mayo Clinic Staff. Diseases-conditions/hyperparathyroidism/treatment. http://www.mayoclinic.org (accessed January 16, 2014).
  8. ↑ Hamdy N. A patient with persistent primary hyperparathyroidism due to a second ectopic adenoma. Natural Clinical Practice Endocrinology and Metabolism. [Serial on the Internet].2007 [cited 2014 Jan. 17];3:311-315. Available from:fckLRhttp://www.nature.com/nrendo/journal/v3/n3/full/ncpendmet0448.html
  9. ↑ Forman B.H., Ciardiello K., Landau S.J., Freedman J.K. (1995) 'Diplopia associated with hyperparathyroidism: report of a case', Yale J Biol Med, 68(5-6), pp. 215-217 [Online]. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588946/ (Accessed: 17th January 2014).
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