hyperparathyroidism
HYPERPARATHYROIDISM

Hyperparathyroidism is a condition wherein there is an excessive production of parathyroid hormone (PTH).

Primary hyperparathyroidism is the most common endocrine disorder and an important cause of hypercalcemia in ambulatory patients.

Classic signs and symptoms include bone disease, kidney stones and hypercalcinosis.

Primary goal of pharmacological therapy is to normalize calcium levels.

 

Prevention

  • For patients taking thiazide diuretics, discontinue for 2 weeks before serum calcium level measurement is repeated
  • Recommended for patients who do not undergo sugery
    • Avoid hypercalcemia-aggravating factors
    • Encourage physical activity to minimize bone resorption
    • Adequate hydration is encouraged to minimize nephrolithiasis risk
    • Moderate calcium intake (1000 mg/day) should be maintained
    • Moderate calcium restriction (<800 mg/day) is warranted in patients w/ high serum calcitriol concentration
    • Maintain moderate vitamin D intake (400-800 IU 24 hrly) to maintain 25-(OH)-D level of at least 20 or 30 ng/mL (50 or 75 mmol/L)

Follow Up

  • Annual serum calcium, creatinine & eGFR assessment
  • 3-site dual energy x-ray absorptiometry scan should be done every 1-2 years
  • Bone mineral density assessment every 1-2 years in cases of chronic disorder
  • Radiograph or vertebral fracture assessment done in patients suspected w/ vertebral fracture (ie back pain, height loss)
  • 24-hour biochemical stone profile done once indicated in suspected cases of renal nephrolithiasis or nephrocalcinosis
  • Abdominal imaging w/ radiography, CT or ultrasound is recommended in patients suspected w/ renal nephrolithiasis or nephrocalcinosis
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