Endocrine - Parathyroid

Part 1

Parathyroid - description

• 4 Parathyroid glands• Behind thyroid (lobe)

Parathyroid - function

• PTH blood Ca levels

• PTH stimulated by hypocalcemia

• PTH is inhibited by hypercalcemia

PTH - function

• the reabsorption of Ca & P from bone blood

• absorption by sm. Intestine

• reabsorption by kidney• Increases blood Ca levels• Antagonist to Calcitonin• It is the most important

regulator of serum Ca levels.

Calcium

• Why do we need it?– Bones– Teeth– Blood coagulation– Transmission of nerve

impulses– Muscle contraction &

relaxation– Normal heartbeat

Hyperparathyroidism

• Pathophysiology– Parathyroid activity

– PTH – (What does PTH

do?????)– blood Ca levels

(out of control)– Hypercalcemia

Hyperparathyroidism

• Where is the Ca coming from?

• Movement of Ca out of the bones blood

Hyperparathyroidism

• Etiology– Hyperplasia/ tumor

of parathyroid gland– Heredity

Hyperparathyroidism

• S&S– d/t serum Ca levels– Fatigue/– Depression– Confusion– Polyuria– N/V anorexia– Kidney stones

• Renal calculi

• S&S– Cardiac dysrhythmias– Peptic ulcers– Pathological fractures

• Back pain• Bone tenderness

– Coma– Cardiac arrest

Hyperparathyroidism

• Diagnostic tests– serum Ca levels– X-ray

Hyperparathyroidism

• Medical management– Goal = PTH– fluids

Hyperparathyroidism

• Pharmaceutical interventions– Lasix (Furosemide)

• renal secretion of Ca

– Pamidronate (Aredia)

• Calcitonin• Prevents Ca release

from bones

Hyperparathyroidism

• Surgical management– If sever remove – Remove 3 ½ glands– Post OP

• Bone pain gone in 3 days

• Renal damage permanent

HYPOparathyroidism

• Pathophysiology– PTH – blood reabsorption of

Ca from bone – serum Ca levels – Hypocalcemia

Hypoparathyroidism

• Etiology– Heredity– Thyroidectomy

(accidental removal)–

Hypoparathyroidism

• S&S– Hypocalcemia causes

neuromuscular irritability

Hypoparathyroidism

• S&S: Acute– Tetany– Tingling of fingers– Muscle spasms– Twitching– + Chvostek’s sign– + Trousseau’s sign

Hypoparathyroidism

• Chvostek’s sign– Tap facial nerve – Facial spasm

Hypoparathyroidism

• + Trousseau’s sign– Occlusion of brachial

artery > 3 min.– Carpal spasm

Hypoparathyroidism

• Chronic S&S– Lethargy– Muscle spasms– Calcification in eyes

or brain– Convulsions– Laryngospasms

• obstruction of larynx

• deathmosis

Hypoparathyroidism

• Diagnostic tests– Chvostek’s sign– Trousseau’s sign– serum Ca levels– PTH levels

Hypoparathyroidism

• Medical management– IV Ca Glugonate– Breath into bag

• Acidosis• In Ca levels

– In Ca diet– Oral Ca– Vitamin D– Thiazide diuretics

Hypoparathyroidism

• Nursing Management– For S&S tetany– Stridor