Diferencia entre revisiones de «Hypoparathyroidism»
Sin resumen de edición |
Sin resumen de edición |
||
| Línea 1: | Línea 1: | ||
==Background== | ==Background== | ||
*Parathyroid hormone (PTH) increases osteolysis, renal tubular resorption of calcium, and renal synthesis of 1,25-dihydroxycholecalciferol AND inhibits renal tubular reabsorption of phosphate and bicarbonate, leading to net INCREASE in serum calcium | |||
*Hypoparathyroid thus results in [[hypocalcemia]] with [[hyperphosphatemia]] | |||
==Causes== | |||
*Iatrogenic: | |||
**Anterior neck surgery or radiation (e.g. resection of multiple parathyroid adenomas, thyroidectomy); may be transient | |||
**steroids, diuretics, antiepilptics | |||
*Congenital (e.g. [[DiGeorge syndrome]] | |||
*Malignancy | |||
*Autoimmune | |||
*Damage from [[Heavy metals]] (e.g. copper in [[Wilson's disease]]) | |||
*Functional hypoPTH from [[hypomagnesemia]] | |||
==Clinical Features== | ==Clinical Features== | ||
*[[Hypocalcemia]] | *See [[Hypocalcemia]], [[hyperphosphatemia]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Vitamin D deficiency]] | *[[Vitamin D deficiency]] | ||
*Pseudohypoparathyroidism | *Pseudohypoparathyroidism (renal resistance to PTH) | ||
*Kidney disease | *Kidney disease | ||
*Malabsorption | *Malabsorption | ||
*Iatrogenic: steroids, diuretics, antiepilptics | *Iatrogenic: | ||
**Anterior neck surgery or radiation (e.g. resection of multiple parathyroid adenomas, thyroidectomy); may be transient | |||
**steroids, diuretics, antiepilptics | |||
*Congenital (e.g. [[DiGeorge syndrome]] | |||
*Malignancy | |||
*Autoimmune | |||
*Damage from [[Heavy metals]] (e.g. copper in [[Wilson's disease]]) | |||
*Functional hypoPTH from [[hypomagnesemia]] | |||
==Evaluation== | ==Evaluation== | ||
*CPM | *CPM | ||
*PTH | **Low serum calcium | ||
**Normal alk phos | |||
*PTH (low or inappropriately normal in setting of hypocalcemia) | |||
*EKG | *EKG | ||
*Magnesium levels | *Magnesium levels | ||
*Phosphate levels | *Phosphate levels (high) | ||
==Management== | |||
==Management== | ==Management== | ||
*Treat underlying condition | |||
===Hypocalcemia=== | |||
''Avoid empiric treatment in patients taking digoxin due to risk for [[Stone Heart]]'' | |||
*Asymptomatic | |||
**Calcium gluconate 1 gm PO Q6hrs | |||
**Vitamin D (calcitriol) 0.2 mcg BID | |||
*Symptomatic | |||
**Calcium gluconate/chloride 10mL of 10% soln IV over 10min | |||
*Correct [[hypomag]] at same time (otherwise PTH is inhibited) | |||
*Avoid phenothiazine [[antipsychotics]] (may precipitate extrapyramidal symptoms) | |||
*Avoid [[furosemide]] (may worsen hypocalcemia) | |||
==Disposition== | ==Disposition== | ||
*Admit if symptomatic hypocalcemia | |||
==See Also== | ==See Also== | ||
*[[Hypocalcemia]], [[hyperphosphatemia]] | |||
*[[Electrolyte Abnormalities (Main)]] | |||
==External Links== | ==External Links== | ||
| Línea 27: | Línea 66: | ||
[[Category:Endocrinology]] | [[Category:Endocrinology]] | ||
[[Category:FEN]] | |||
Revisión del 00:05 27 ene 2019
Background
- Parathyroid hormone (PTH) increases osteolysis, renal tubular resorption of calcium, and renal synthesis of 1,25-dihydroxycholecalciferol AND inhibits renal tubular reabsorption of phosphate and bicarbonate, leading to net INCREASE in serum calcium
- Hypoparathyroid thus results in hypocalcemia with hyperphosphatemia
Causes
- Iatrogenic:
- Anterior neck surgery or radiation (e.g. resection of multiple parathyroid adenomas, thyroidectomy); may be transient
- steroids, diuretics, antiepilptics
- Congenital (e.g. DiGeorge syndrome
- Malignancy
- Autoimmune
- Damage from Heavy metals (e.g. copper in Wilson's disease)
- Functional hypoPTH from hypomagnesemia
Clinical Features
Differential Diagnosis
- Vitamin D deficiency
- Pseudohypoparathyroidism (renal resistance to PTH)
- Kidney disease
- Malabsorption
- Iatrogenic:
- Anterior neck surgery or radiation (e.g. resection of multiple parathyroid adenomas, thyroidectomy); may be transient
- steroids, diuretics, antiepilptics
- Congenital (e.g. DiGeorge syndrome
- Malignancy
- Autoimmune
- Damage from Heavy metals (e.g. copper in Wilson's disease)
- Functional hypoPTH from hypomagnesemia
Evaluation
- CPM
- Low serum calcium
- Normal alk phos
- PTH (low or inappropriately normal in setting of hypocalcemia)
- EKG
- Magnesium levels
- Phosphate levels (high)
Management
Management
- Treat underlying condition
Hypocalcemia
Avoid empiric treatment in patients taking digoxin due to risk for Stone Heart
- Asymptomatic
- Calcium gluconate 1 gm PO Q6hrs
- Vitamin D (calcitriol) 0.2 mcg BID
- Symptomatic
- Calcium gluconate/chloride 10mL of 10% soln IV over 10min
- Correct hypomag at same time (otherwise PTH is inhibited)
- Avoid phenothiazine antipsychotics (may precipitate extrapyramidal symptoms)
- Avoid furosemide (may worsen hypocalcemia)
Disposition
- Admit if symptomatic hypocalcemia