hormonal and metabolic disorders
Hyperparathyroidism
Treatment of Hyperparathyroidism
Measures to lower blood calcium level Often surgery Treatment for hyperparathyroidism depends on its severity. For people with primary hyperparathyroidism who have no symptoms and for whom surgery is not indicated, the underlying hypercalcemia may be treated with measures designed to lower the level of calcium in the blood. Doctors encourage people to remain active because inactivity could worsen hypercalcemia. Doctors may also recommend that people follow a low-calcium diet, drink plenty of fluid to minimize the chance of Stones in the Urinary Tract , and avoid medications that can raise the blood calcium level (for example, thiazide diuretics, which may be used to treat high blood pressure or heart failure). For people with severe hypercalcemia caused by primary hyperparathyroidism who are unable to undergo surgery, doctors sometimes prescribe medications that lower PTH and calcium levels, such ascinacalcetoretelcalcetide. Surgery to remove the parathyroid glands (parathyroidectomy) is indicated for people with symptoms and for those with worsening hyperparathyroidism. Whether people with primary hyperparathyroidism who have no symptoms need surgery is unclear. Many experts, however, recommend surgery when Laboratory values in the blood and urine (for example, abnormalities in calcium and creatinine) reach certain levels. Bone density at the hip and/or lumbar spine is low. The person is younger than 50 years old. The person may not follow up appropriately with the prescribed treatment. During surgery, a parathyroid gland that has an adenoma is removed. Theparathyroid hormone(PTH) level in the blood is measured before and after removal of the abnormal gland(s). If PTH levels fall by 50% or more 10 minutes after the adenoma is removed, the treatment is considered a success. In people with hyperplasia of all parathyroid glands, surgery involves removal of each gland. A small portion of a normal-appearing parathyroid gland is reimplanted in one of the sternocleidomastoid muscles on either side of the neck or under the skin in the forearm. Reimplantation is done to prevent Hypoparathyroidism , a deficiency of PTH. Occasionally, parathyroid tissue is set aside and frozen (called cryopreservation) to allow for later transplantation in the same person in case persistent hypoparathyroidism develops. When hyperparathyroidism has been mild, blood calcium levels drop to just below normal within 24 to 48 hours after surgery. In moderate and severe hyperparathyroidism, calcium levels must be monitored closely for the first several days after surgery to make sure calcium does not go too low. Hyperparathyroidism in people with Overview of Kidney Failure is due to a complex set of problems involving Hyperphosphatemia(excess phosphate in the blood) should be prevented or treated if present in people with kidney failure. Doctors restrict the amount of phosphate in the person's diet and prescribe phosphate-binding agents, such ascalcium carbonate,calcium acetate, lanthanum, orsevelamerto be take with each meal. Both approaches are usually needed, especially in patients with kidney failure who are on dialysis. People with kidney failure frequently needvitamin Dsupplements to improve calcium absorption, but the improved calcium absorption can increase phosphate absorption too and contribute to hyperparathyroidism. People with advanced kidney disease, especially those with kidney failure, require close monitoring of their calcium and phosphate levels and frequent adjustment of the dosages of the medications they are taking. Doctors can also givecinacalcetoretelcalcetideto people receiving dialysis to decrease the level of PTH whenvitamin D, phosphate restriction, or phosphate binders are ineffective or unable to be used safely. 