Professional Documents
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Endocrinology
Endocrinology
Parathyroid Gland
Parathyroid
Anatomy
Parathyroid Hormone
Parathyroid hormone is the most important
endocine regulator of calcium and
phosphorous concentration in the extracellular
fluid.
This hormone is secreted from cells of the
parathyroid glands and finds its major target
cells in bone and kidney.
Physiologic Effect of Parathyroid
hormone
The effect of Parathyroid hormone goes with
the principle of negative feedback system, if
calcium ion concentrations in extracellular
fluid fall below normal, bring them back
within the normal range.
In conjunction with increasing calcium
concentration, the concentration of phosphate
ion in blood is reduced.
Physiologic Effect of Parathyroid
hormone
Mobilization of calcium from bone: Although
the mechanisms remain obscure, a well-
documented effect of parathyroid hormone is
to stimulate osteoclasts to reabsorb bone
mineral, liberating calcium into blood.
Physiologic Effect of Parathyroid
hormone
Enhancing absorption of calcium from the
small intestine:
Parathyroid hormone stimulates this process,
by stimulating production of the active form
of vitamin D in the kidney. Vitamin D induces
synthesis of a calcium-binding protein in
intestinal epithelial cells that facilitates
efficient absorption of calcium into blood.
Physiologic Effect of Parathyroid
hormone
Suppression of calcium loss in urine:
Parathyroid hormone puts a brake on
excretion of calcium in urine, thus conserving
calcium in blood. This effect is mediated by
stimulating tubular reabsorption of calcium.
Another effect of parathyroid hormone on the
kidney is to stimulate loss of phosphate ions in
urine.
Physiologic Effect of Parathyroid
Hormone
Hyperparathyroidism
Hyperparathyroidism results from
excessive secretion of parathyroid
hormone (PTH). PTH promotes bone
resorption, and hypersecretion leads to
hypercalcemia and hypophosphatemia.
- peptic ulcer
- pancreatitis
- abdominal pain ranging to the back
- nausea and vomiting
Diagnostic Findings
Radioimmunoassay (confirms the diagnosis)
X-rays showing diffused demineralization of bones
Spectrophotometry
Ultrasound, MRI, thallium scan, and
fine-needle biopsy have been used to evaluate the
function of the parathyroids and to localize
parathyroid cysts, adenomas, or hyperplasia.
Treatment
Surgery
- The recommended treatment of primary
hyperparathyroidism is the surgical removal of
abnormal parathyroid tissue.
The nursing management of the patient
undergoing parathyroidectomy is essentially the
same as that of a patient undergoing
thyroidectomy.
Nursing management
Increased fluid intake (3-4L/day).
- to reduce risk of stone formation in the
kidneys and relieve thirst due to polyuria.
Acid-ash fruit juices (prune juice, cranberry
juice) ascorbic acid.
- acidic urine inhibits stone formation in the
kidneys. This will also prevent constipation to
patient.
Protect from injury to prevent fracture.
Normal saline IV.