Pediatric Hyperparathyroidism Follow-up
- Author: Gordon L Klein, MD, MPH; Chief Editor: Stephen Kemp, MD, PhD more...
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 multiple endocrine neoplasia type 1 (MEN I).
For secondary hyperparathyroidism, outpatient care includes management and control of the underlying condition.
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.
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 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 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.
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 entirely depends on the success of managing the primary disease process.
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
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