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Pediatric Hyperparathyroidism Follow-up

  • Author: Gordon L Klein, MD, MPH; Chief Editor: Stephen Kemp, MD, PhD  more...
 
Updated: Dec 03, 2014
 

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.

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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.

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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.

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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.

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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.

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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 entirely depends on the success of managing the primary disease process.

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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
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Contributor Information and Disclosures
Author

Gordon L Klein, MD, MPH Clinical Professor of Orthopedic Surgery and Rehabilitation, University of Texas Medical Branch School of Medicine

Gordon L Klein, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, American Society for Nutrition, American Gastroenterological Association, American Pediatric Society, American Society for Bone and Mineral Research, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) Professor and Chair, First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, Greece; UNESCO Chair on Adolescent Health Care, University of Athens, Greece

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) is a member of the following medical societies: American Academy of Pediatrics, American College of Physicians, American Pediatric Society, American Society for Clinical Investigation, Association of American Physicians, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research, American College of Endocrinology

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD Former Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas for Medical Sciences College of Medicine, 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, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Phyllis W Speiser, MD Chief, Division of Pediatric Endocrinology, Steven and Alexandra Cohen Children's Medical Center of New York; Professor of Pediatrics, Hofstra-North Shore LIJ School of Medicine at Hofstra University

Phyllis W Speiser, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

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Normal parathyroid glands as seen during a thyroidectomy. The large arrow points to the superior parathyroid. The thinner arrow points to the inferior parathyroid. The forceps points toward the recurrent laryngeal nerve. The patient's head is toward the right.
 
 
 
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