eMedicine Specialties > Pediatrics: General Medicine > Endocrinology

Hyperparathyroidism: Follow-up

Author: Gordon L Klein, MD, MPH, Professor, Departments of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Texas Medical Branch
Contributor Information and Disclosures

Updated: Aug 13, 2008

Follow-up

Further Inpatient Care

  • Further inpatient care depends on the nature of the diagnosis and why the patient was admitted.
  • For a parathyroidectomy, the patient's serum calcium level must be postoperatively monitored to determine if any evidence of transient postoperative hypocalcemia or hungry bone syndrome is present.
  • Monitor wound healing and observe for damage to the recurrent laryngeal nerve.
  • Because management is often medical for secondary hyperparathyroidism, further care depends on efforts to control the underlying problem, thereby improving hyperparathyroidism; management also often involves initial use of calcitriol to find the appropriate dose for maintenance of the patient.

Further Outpatient Care

  • Outpatient care for postparathyroidectomy patients involves continued monitoring of serum calcium levels (if low at discharge) and observation of wound healing.
  • Furthermore, care should include treatment of accompanying tumors, such as in MEN I.
  • For secondary hyperparathyroidism, outpatient care includes management and control of the underlying condition.

Inpatient & Outpatient Medications

  • Calcitriol is a vitamin D metabolite administered to help suppress excessive PTH release and blunt the hyperparathyroid response to chronic renal failure.

Transfer

  • Transfer to another facility is necessary only if current facilities cannot provide the expertise of an endocrinologist, surgeon, or subspecialist for an exacerbation of underlying disease.

Complications

  • Complications of primary hyperparathyroidism include consequences of hypercalcemia, such as nephrolithiasis, dehydration, and cardiac arrhythmias.
  • Complications of secondary hyperparathyroidism are mainly skeletal and involve fractures, decreased bone density, bone pain, and muscle weakness.

Prognosis

  • For primary hyperparathyroidism, parathyroidectomy should be curative if the condition occurs in isolation. However, if it is associated with other tumors, then prognosis depends on the management of accompanying tumors.
  • For secondary hyperparathyroidism, prognosis depends entirely on the success of managing the primary disease process.

Patient Education

  • Patients with primary hyperparathyroidism must understand the following:
    • Location and function of parathyroid gland and PTH
    • Effects of hypercalcemia on the body (eg, arrhythmia, stones, bone demineralization, increased fracture risk)
    • Lack of success in managing primary hyperparathyroidism medically, need for surgical consultation, and possible removal of one or more parathyroid glands
  • Patients with secondary hyperparathyroidism must understand the following:
    • The mechanism by which the underlying condition causes secondary hyperparathyroidism
    • Effects on the body (eg, bone pain, bone demineralization, increased fracture risk, muscle weakness)
    • Proper management of secondary hyperparathyroidism in each individual case

Miscellaneous

Medicolegal Pitfalls

  • Inasmuch as primary hyperparathyroidism may be asymptomatic, mild hypercalcemia incidentally found on a screening test of serum electrolytes may not be diagnostically pursued. Failure to repeat the serum calcium determination and obtain serum intact PTH concentration to detect consistent elevation of serum calcium concentration in the face of elevated serum levels of intact PTH results in failure to diagnose the condition as primary hyperparathyroidism.
  • Conversely, symptoms such as nausea, vomiting, and constipation, although characteristic of hypercalcemia, may lead to pursuing other diagnostic possibilities. Failure to check serum calcium levels in children presenting with nausea and vomiting may lead to a missed diagnosis of primary hyperparathyroidism.
  • Failure to diagnose an underlying cause for hypercalcemia, such as renal failure or malignancy, is another medicolegal pitfall.
  • Clinicians should be aware of the possibility of MEN in cases of familial hyperparathyroidism due to adenomas. Careful family history must be taken for hypercalcemia, parathyroid adenomas, Zollinger-Ellison syndrome, and other MEN-associated problems. The family should be counseled accordingly if history is positive.

Special Concerns

  • Pediatrics: Because of the high frequency of gastrointestinal symptoms, such as abdominal pain and constipation, among school-aged children and adolescents, checking blood ionized calcium concentration as part of a routine workup of the above-mentioned symptoms is prudent.
 


More on Hyperparathyroidism

Overview: Hyperparathyroidism
Differential Diagnoses & Workup: Hyperparathyroidism
Treatment & Medication: Hyperparathyroidism
Follow-up: Hyperparathyroidism
References
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References

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Further Reading

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Keywords

hyperparathyroidism, primary hyperparathyroidism, secondary hyperparathyroidism, tertiary hyperparathyroidism, parathyroid adenoma, parathyroid hyperplasia, hypocalcemia, intestinal malabsorption, chronic renal failure, multiple endocrine neoplasia, MEN, nutritional rickets, hypercalcemia, bradycardia, dehydration, jaw tumors, Wilms tumor, fractures, Zollinger-Ellison tumors, pancreatitis, urolithiasis, nephrolithiasis, nephrocalcinosis, bone resorption, vitamin D malabsorption, cholestatic liver disease, Paget disease

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Contributor Information and Disclosures

Author

Gordon L Klein, MD, MPH, Professor, Departments of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Texas Medical Branch
Gordon L Klein, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, American Gastroenterological Association, American Pediatric Society, American Society for Bone and Mineral Research, American Society for Clinical Nutrition, American Society for Nutritional Sciences, North American Society for Pediatric Gastroenterology and Nutrition, Sigma Xi, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Medical Editor

Phyllis W Speiser, MD, Chief of Pediatric Endocrinology, Schneider Children's Hospital; Professor of Pediatrics, New York University School of Medicine
Phyllis W Speiser, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

George P Chrousos, MD, FAAP, MACP, MACE, Professor and Chair, Department of Pediatrics, Athens University Medical School
George P Chrousos, MD, FAAP, MACP, MACE is a member of the following medical societies: American Academy of Pediatrics, American College of Endocrinology, American College of Physicians, American Pediatric Society, American Society for Clinical Investigation, Association of American Physicians, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD, Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas and Arkansas Children's Hospital
Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, and Southern Society for Pediatric Research
Disclosure: Genentech, Inc. Honoraria Speaking and teaching; Pfiser, Inc. Honoraria Consulting

 
 
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