Pediatric Hyperparathyroidism Follow-up

Updated: Apr 17, 2017
  • Author: Edna E Mancilla, MD; Chief Editor: Sasigarn A Bowden, MD  more...
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Follow-up

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).

 

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Further Inpatient Care

 

Post-parathyroidectomy, the patient's serum calcium level must be closely 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.

 

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Inpatient & Outpatient Medications

Cases of transient hypoparathyroidism post resection of an adenoma require treatment with calcium or calcium and calcitriol until calcemia has normalized, usually no longer than the first post-operative week. Calcium supplements may be required for a longer period in the presence of hungry bone syndrome.

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Transfer

Transfer to another facility is necessary only if current facilities cannot provide the expertise of an endocrinologist, or experienced surgeon. The surgeon's experience is an important factor in the outcome of parathyroidectomies.

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Complications

Surgical complications include recurrent laryngeal nerve injury, bleeding and infection. Complications of primary hyperparathyroidism include consequences of hypercalcemia, such as nephrolithiasis, dehydration, and cardiac arrhythmias, and complications due to end organ involvement such as renal failure and fractures.

 

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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,  prognosis would depend on the management of accompanying tumors.

 

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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, dehydration, neurological symptoms, arrhythmia, stones, bone demineralization, increased fracture risk)

  • Lack of success in managing primary hyperparathyroidism medically, need for surgical consultation, and resection of one or more parathyroid glands

 

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