Hyperparathyroidism in Emergency Medicine Follow-up

  • Author: Philip N Salen, MD; Chief Editor: Erik D Schraga, MD   more...
 
Updated: Apr 6, 2010
 

Further Inpatient Care

  • Admit patients with significant symptoms due to hyperparathyroid-induced hypercalcemia and substantial elevations of calcium levels.
  • Patients who are markedly symptomatic or those with significant electrolyte disturbances should be evaluated by endocrinologists and surgeons experienced in parathyroid removal.
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Further Outpatient Care

  • Calcium levels must be periodically monitored for several months postparathyroidectomy.
  • If calcium levels begin to rise postoperatively, the patient needs to be evaluated for possible accessory parathyroid glands.
  • Monitor asymptomatic patients for worsening hypercalcemia, deteriorating bone density or renal function, and other complications of hyperparathyroidism.
  • If the serum calcium concentration falls below 8 mg/dL postparathyroidectomy with a concomitant rise in serum phosphate level, consider the possibility of postsurgical hypoparathyroidism.
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Deterrence/Prevention

  • Although patients should refrain from the ingestion of more calcium than is recommended for adults (1200-1500 mg/d), the calcium intake should not be excessively restricted (to < 750 mg/d) because calcium-poor diets may promote processes associated with excessive secretion of parathyroid hormone (PTH).
  • Because many patients with asymptomatic primary hyperparathyroidism have levels of 25-hydroxyvitamin D that are at the lower end of the reference range or frankly low, the addition of a low level of supplementation achievable with a multivitamin (400 IU of vitamin D daily) is advisable.
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Complications

  • Maternal hyperparathyroidism can lead to profound hypocalcemia and tetany, coma, and death in newborns in a syndrome known as neonatal severe hyperparathyroidism.
  • Nocturia and polyuria may result from the effects of elevated calcium levels on the renal tubule.
  • Approximately 20% of patients with hyperparathyroidism have nephrolithiasis.
  • CNS disturbances, coma, and death may result from markedly elevated serum calcium levels when left untreated.
  • Skeletal sequelae (eg, pathologic fracture) may occur.
  • Heart failure may occur.
  • Surgical complications include the following:
    • Hypoparathyroidism
    • Recurrent laryngeal nerve damage
    • Hemorrhage
    • Infection
    • Unsuccessful surgery
      • Persistent or recurrent disease occurs in 5-10% of individuals who undergo surgery for primary hyperparathyroidism.[18]
      • Persistent primary hyperparathyroidism is defined as the presence of elevated serum calcium levels and PTH levels documented within 6 months of the initial operation. The most common cause of persistent primary hyperparathyroidism is the presence of a missed parathyroid adenoma, which is usually in an ectopic location in this setting. Less commonly, persistent disease may be secondary to inadequate resection of unappreciated multigland disease.[18]
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Prognosis

  • The prognosis is excellent for patients after successful parathyroidectomy.
  • Asymptomatic patients who do not have indications for surgery have an excellent prognosis. Significant bone loss and other symptoms may be absent for years in subsequent follow-up visits.
  • Secondary hyperparathyroidism is associated with a poor prognosis likely due to underlying advanced chronic renal failure and resultant chronic hypocalcemia.
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Patient Education

  • Educate patients about prescribed medications.
  • Educate patients regarding the importance of periodic laboratory and radiologic testing.
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Contributor Information and Disclosures
Author

Philip N Salen, MD  Clinical Professor, Department of Emergency Medicine, PA Program, Desales University; Adjunct Clinical Associate Professor, Department of Emergency Medicine, Temple University Medical School; Research Director, Emergency Medicine Education, Saint Luke's Hospital

Philip N Salen, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jeffrey L Arnold, MD, FACEP  Chairman, Department of Emergency Medicine, Santa Clara Valley Medical Center

Jeffrey L Arnold, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

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