Hyperparathyroidism - Revision history

Rossdonaldson1: /* Clinical Features */

2020-11-27T00:18:48Z

Clinical Features

← Older revision		Revision as of 00:18, 27 November 2020
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	{{Hypercalcemia clinical features}}		{{Hypercalcemia clinical features}}

	~~===Symptoms of [[hypocalcemia]]===~~		{{Hypocalcemia clinical features}}
	**Paresthesias (mouth, fingertips)
	**↑ DTRs
	**Cramps
	**[[Weakness]]
	**[[Confusion]]
	**[[Seizures]]
	**Chvostek/Trousseau signs, Tetany
	**[[Hallucinations]]
	**[[Laryngospasm]]
	**Bronchospasm
	**Cardiac [[dysrhythmias]]

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Clinical Features */

2020-11-27T00:15:30Z

Clinical Features

← Older revision		Revision as of 00:15, 27 November 2020
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	*Asymptomatic, often		*Asymptomatic, often
	*[[Hypercalcemia]] features if primary		*[[Hypercalcemia]] features if primary
			*[[Hypocalcemia]] features if secondary

	{{Hypercalcemia clinical features}}		{{Hypercalcemia clinical features}}

	*[[~~Hypocalcemia~~]] ~~features if secondary~~		===Symptoms of [[hypocalcemia]]===
	**Paresthesias (mouth, fingertips)		**Paresthesias (mouth, fingertips)
	**↑ DTRs		**↑ DTRs
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	**Chvostek/Trousseau signs, Tetany		**Chvostek/Trousseau signs, Tetany
	**[[Hallucinations]]		**[[Hallucinations]]
	**Laryngospasm		**[[Laryngospasm]]
	**Bronchospasm		**Bronchospasm
	**Cardiac [[dysrhythmias]]		**Cardiac [[dysrhythmias]]

Rossdonaldson1: /* Clinical Features */

2020-11-27T00:14:50Z

Clinical Features

← Older revision		Revision as of 00:14, 27 November 2020
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	**Bronchospasm		**Bronchospasm
	**Cardiac [[dysrhythmias]]		**Cardiac [[dysrhythmias]]


	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Background */

2020-11-27T00:07:21Z

Background

← Older revision		Revision as of 00:07, 27 November 2020
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	==Background==		==Background==
	*Causes:		===Causes===
	**Parathyroid adenoma (most common), parathyroid hyperplasia, parathyroid carcinoma		*Parathyroid adenoma (most common), parathyroid hyperplasia, parathyroid carcinoma
	**[[Milk alkali syndrome]]		*[[Milk alkali syndrome]]
	**Granulomatous		*Granulomatous
	**Secondary hyperparathyroidism (response to [[hypocalcemia]])		*Secondary hyperparathyroidism (response to [[hypocalcemia]])
	**Tertiary hyperparathyroidism due to CKD		*Tertiary hyperparathyroidism due to CKD

	==Clinical Features==		==Clinical Features==

ClaireLewis: Created page with "==Background== *Causes: Parathyroid adenoma (most common), parathyroid hyperplasia, parathyroid carcinoma Milk alkali syndrome Granulomatous Secondary hyperparathy..."

2019-08-24T20:54:48Z

Created page with "==Background== *Causes: **Parathyroid adenoma (most common), parathyroid hyperplasia, parathyroid carcinoma **Milk alkali syndrome **Granulomatous **Secondary hyperparathy..."

New page

==Background==
*Causes:
**Parathyroid adenoma (most common), parathyroid hyperplasia, parathyroid carcinoma
**[[Milk alkali syndrome]]
**Granulomatous
**Secondary hyperparathyroidism (response to [[hypocalcemia]])
**Tertiary hyperparathyroidism due to CKD

==Clinical Features==
*Asymptomatic, often
*[[Hypercalcemia]] features if primary
{{Hypercalcemia clinical features}}

*[[Hypocalcemia]] features if secondary
**Paresthesias (mouth, fingertips)
**↑ DTRs
**Cramps
**[[Weakness]]
**[[Confusion]]
**[[Seizures]]
**Chvostek/Trousseau signs, Tetany
**[[Hallucinations]]
**Laryngospasm
**Bronchospasm
**Cardiac [[dysrhythmias]]

==Differential Diagnosis==
{{Hypercalcemia DDX}}
{{Jaw spasms DDX}}

==Evaluation==
*Evaluate for underlying etiology/alternate diagnoses of symptoms
*PTH- elevated
*Calcium- elevated if primary, low if secondary
*Phosphate- low in primary, high in secondary
*Alk phos- elevated

==Management==
===[[Hypocalcemia]]===
''Avoid empiric treatment in patients taking digoxin due to risk for [[Stone Heart]]''
*Asymptomatic
**[[Calcium gluconate]] 1 gm PO Q6hrs
**Vitamin D (calcitriol) 0.2 mcg BID
*Symptomatic
**[[Calcium gluconate]]/[[calcium chloride]] 10mL of 10% soln IV over 10min
*Correct [[hypomag]] at same time (otherwise PTH is inhibited)
*Avoid phenothiazine [[antipsychotics]] (may precipitate extrapyramidal symptoms)
*Avoid [[furosemide]] (may worsen hypocalcemia)

===[[Hypercalcemia]]===
====Asymptomatic or Ca <12 mg/dL====
*Does not require immediate treatment
*Advise to avoid factors that can aggravate hypercalcemia (thiazide diuretics, Li, volume depletion, prolonged inactivity, high Ca diet)

====Mildly symptomatic Ca 12-14 mg/dL====
*May not require immediate therapy; however, an acute rise may cause symptoms necessitating treatment as described for severe hypercalcemia (see below)

====Symptomatic or Severe hypercalcemia (Ca >14 mg/dL)====
*Patients are likely dehydrated and require saline hydration as initial therapy

=====Hydration=====
*Isotonic saline at 200-300 mL/hour; adjust to maintain urine output at 100-150 mL/hour

=====[[Calcitonin]]=====
*Consider adding calcitonin 4 units/kg SC or IV q12hr in patients w/ Ca >14 mg/dL (3.5 mmol/L) who are also symptomatic (lowers Ca w/in 2-4hr)
*Tachyphylaxis limits use long term, but is a great choice for emergent cases

=====Bisphosphonates=====
Give for severe hypercalcemia due to excessive bone resorption (lowers Ca within 12-48hr)
*Pamidronate 90mg IV over 24 hours OR
*[[Zoledronate]] 4mg IV over 15 minutes
*Caution in renal failure, though bisphosphonates have been safely used in pts with pre-existing renal failure<ref>LeGrand SB et al. Narrative Review: Furosemide for Hypercalcemia: An Unproven yet Common Practice. Ann Intern Med. 2008;149:259-263.</ref>

=====Electrolyte Repletion=====
*Correct [[hypokalemia]]
*Correct [[hypomagnesemia]]

=====Diuresis=====
*[[Furosemide]] is NOT routinely recommended
*Only consider in patients with renal insufficiency or heart failure and volume overload

=====[[Dialysis]]=====
Consider if patient:
*Anuric with Renal Failure
*Failing all other therapy
*Severe hypervolemia not amenable to diuresis
*Serum Calcium level >18mg/dL

=====[[Corticosteroids]]=====
''Decrease Ca mobilization from bone and are helpful with steroid-sensitive tumors (e.g. lymphoma, MM)''
*[[Prednisone]] 60mg PO daily

==Disposition==

==See Also==
*[[Hypercalcemia]]
*[[Hypocalcemia]]

==External Links==

==References==
<references/>

[[Category:FEN]]

Hyperparathyroidism - Revision history

Rossdonaldson1: /* Clinical Features */

Rossdonaldson1: /* Clinical Features */

Rossdonaldson1: /* Clinical Features */

Rossdonaldson1: /* Background */

ClaireLewis: Created page with "==Background== *Causes: **Parathyroid adenoma (most common), parathyroid hyperplasia, parathyroid carcinoma **Milk alkali syndrome **Granulomatous **Secondary hyperparathy..."

ClaireLewis: Created page with "==Background== *Causes: Parathyroid adenoma (most common), parathyroid hyperplasia, parathyroid carcinoma Milk alkali syndrome Granulomatous Secondary hyperparathy..."