PARATHYROID DISORDERS

Parathyroid Gland

The parathyroid glands four in number, lie posterior and adjacent to the thyroid gland. There are two cells types:

Oxyphil cell Chief cell responsible for producing and secreting PTH

Functions of PTH

The normal function of PTH is to increase bone resorption, thereby maintaining the proper balance of:

calcium and phospohorus ions in the blood.

Vit D & calcitonin also affect calcium metabolism

Laboratory Profile
Hyper Hypo

Serum Calcium Serum Phosphate Serum PTH

9.0-10.5 mg/dl or 2.2 2.75 SI units 3.0-4.5 mg/dl or 0.97 1.45 SI units C terminal 50330 pg/ml

Parathyroid Hormone

To maintain calcium levels, PTH acts on:

Bones Kidneys Intestines

To induce reabsorption of calcium

Action and Feedback of PTH

PTHs most Important Effects:

Increase plasma calcium concentration and decrease plasma phosphate concentration Increase urinary excretion of phosphate but decrease urinary excretion of calcium Increase the rate of skeletal remodeling and the net rate of the bone reabsorption Increase the number of osteoblast and osteoclast on bone surfaces

PTHs most Important Effects:

Cause an initial increase in calcium entry into the cell of its target tissue Alter the acid base balance of the body Increase gastrointestinal absorption of calcium

HYPERPARATHYROIDISM
Etiology/Risk Factors

Primary: -normal regulatory relationship between serum calcium levels and PTH secretion is interrupted -parathyroid adenoma -hyperplasia of the gland exists with out an identifying injury -parathyroid carcinoma

Secondary: -glands are hyperplastic because of malfunction of another organ system -Osteogenesis Imperfecta -Pagets Disease -Multiple Myeloma -Carcinoma with bone metastasis
Renal Failure GFR serum phosphorus level calcium level PTH secretion is stimulated PTH

Tertiary: -PTH production is irrepressible (autonomous) in clients with normal or low serum calcium levels

 PTH

stimulates transport of calcium into the blood from: -kidneys -intestines -bones

excessive osteoclastic and osteocytic activity

bone resorption

pathologic fractures

kyphosis of the dorsal spine serum calcium level -backache -joint pain - bone pain

compression fractures of the vertebral bodies

 PTH renal phosphate excretion Renal filtration

RENAL

affects proximal renal tubular function metabolic acidosis abnormal alkaline urine

impairs the concentrating ability of the renal tubule ADH response Polyuria

hypophosphatemia

hyperphosphaturia

hypercalcuria

sand gravel or stones (calculi) in the urine

calcium stones particularly in renal pelvis or renal collecting ducts

Infection

impaired renal function

azotemia

uremia

renal damage

hypertension

fatal renal hypertension

psychiatric manifestations: -listlessness -depression -paranoia

neuromuscular irritability

Calcification may form (eyes)

gastrointestinal manifestation:

mild insulin resistance

Impaired vision
affects the heart

Stimulate hypergastremia Abdominal pain

glucose level

depress contractility of the muscle walls

ECG: decreases the QT interval

Other gastrointestinal manifestation: -thirst -n/v -anorexia -constipation -ileus

Peptic ulcer disease Gastrointestinal bleeding

Complications:
Hypercalcemia Gastrointestinal problems Skeletal damage Renal damage

HYPOPARATHYROIDISM
Etiology/Risk Factors Iatrogenic: -accidental removal of the parathyroid glands during thyroidectomy -infarction of the parathyroid glands because of an inadequate blood supply to the glands during surgery -strangulation of one or more of the glands by postoperative scar tissue Idiophatic: -autoimmune -Pseudohypoparathyroidism (Albrights Herediatry Osteodystrophy) - is an inherited form of hypoparathyroidism that involves a lack of end organ responsiveness to PTH.

PTH

impaired resorption of calcium from bones

impaired regulation of calcium reabsorption from renal tubules

Kidneys: fewer phosphorus ions are secreted by the distal tubules renal excretion of phosphate serum phosphate level

calcium hyperphosphotemia

+Chvostek sign +Trousseau sign +Erb sign

severe neuromuscular irritability develops Tetany:

Ectopic or unexpected calcification may appear

affects the heart dysrhythmias cardiac failure

ECG: -lengthening of the QT interval

Eyes -painful muscle spasms -irritability -grimacing -tingling of the fingers -hyperreflexia -clonic-tonic convulsion

Basal ganglia

larnygospasm death by asphyxiation

Cataracts

Permanent brain damage

-personality changes -psychiatric symptoms: -emotional lability -extreme irritability -anxiety -depression -delirium -convulsion -grandmal seizure

Nails: -Brittle and may atrophy -horizontal ridges apparent

Alopecia occurs in patches on the head

Almost complete loss of eyebrows

Skin: coarse & dry with patches of brownish pigments

Complications:

Acute:
Death

can result from the respiratory obstruction secondary to tetany and laryngospasms in the eye and basal ganglia

Chronic:
Calcification

Bibliography

Black, J & Hawks, J. (2005). Medical Surgical Nursing Clinical Managaement for Positive Outcomes. St. Louis. Elsevier Saunders. 7th Ed. Bullock, Barbara. (1996). PATHOHPYSIOLOGY Adaptations and Alterations in Function. Philadelphia, Lippincott. 4th Ed. Braverman, L. & Utiger, R. (2000). THE THYROID A Fundamental and Clinical Text. Philadelphia. Lippincott. 8th Brunner & Suddarths. (2008). Textbook of Medical-Surgical Nursing. Philadelphia, Lippincott. 11th Ed.

Falk, Stephen. (1997). Thyroid Disease. Endocrinology, Surgery, Nuclear Medicine and Radiotherapy. N.Y., Lippincott.
Guyton, A. & Hall, J. (2006). Textbook of Medical Physiology. Elsevier Saunders. Ignativicious, Donna. (2006). Medical Surgical Nursing Critical Thinking For Collaborative Care. St. Louis. Elsevier Saunders. 5th ed. Mc Cance, K. & Huether, S. (2004). Understanding Pathophysiology. Mosby. 3rd Ed. Porth, Carol. (2005). Concepts of Altered Health Sciences. Philadelphia, Lippincott. 7th Ed.

THANK YOU!!!!