Hiperparatiroid

Widya Gladiantari
1510211068
FK UPN VETERAN JAKARTA
 PRIMARY HYPERPARATHYROIDISM
This disorder occurs in 1 : 500 women and 1:2000 men. It is the most
common cause of hypercalcemia in the outpatient population, and
along with malignancy-associated hypercalcemia accounts for the
majority (>90%) of cases of hypercalcemia.

In sporadic cases, hyperparathyroidism results from a single

enlarged gland (adenoma) in 85%, multiple enlarged glands
(hyperplasia) in 1 1 %, double adenomas in 3%, and parathyroid
carcinoma in 1 % of patients.
Classic symptoms of PHPT
• painful bones
• Renal stones
The disorder may also be associated with :
• abdominal groans
• hypertension
• psychic moans
• Osteopenia
• fatigue overtones
• Osteoporosis
• Nephrolithiasis
Other symptoms • Gout
• Polyuria • Pseudogout
• Nocturia • peptic ulcer disease
• Polydipsia • pancreatitis.
• Constipation
• musculoskeletal aches and pains
Hiperkalsemia ringan (kalsium darah 11-11,5 mg/dL) biasanya asimptomatik dengan
gejala umumnya neuropsikiatrik seperti susah konsentrasi, perubahan personaliti,
dan depresi. Gejala lain yang lebih jarang meliputi peptic ulcer, fraktur, dan
nefrolitiasis.

Severe hypercalcemia (12-13 mg/dL) biasanya disertai dengan gejala letargi,

stupor, koma (jika terjadi secara akut), dan menunjukkan gejala gastrointestinal
seperti nausea, anorexia, konstipasi, dan pankreatitis.

Hypercalcemia decreases renal concentrating ability, which may cause polyuria

and polydipsia. With long-standing hyperparathyroidism, patients may present with
bone pain or pathologic fractures. Finally, hypercalcemia can result in signi cant
electrocardiographic changes, including bradycardia, AV block, and short Q interval;
changes in serum calcium can be monitored by ollowing the Q interval
Dx
PHPT is characterized by hypercalcemia (95%), hypophosphatemia (50%) ,
hyperchloremia (30%), serum chloride to phosphate ratio >= 33 (95%), elevated 24-
hour urinary calcium, and an increased or inappropriately elevated intact PTH. An
elevated alkaline phosphatase level suggests bone disease (osteitis fibrosa cystica) .
The 24-hour urinary calcium levels may be normal or elevated.

Pemeriksaan lab juga harus dilakukan. Apa aja?

Periksa serum PTH, periksa serum kreatinin untuk memantau keadaan ginjal. Jika PTH
meningkat disertai hiperkalsemia dan hipofosfatemia maka dapat dipastikan pasien
kena hiperparatiroidisme primer. Tapi jika PTH meningkat ringan dan ada
hiperkalsemia, bisa ditambahkan FHH (familial hypocaluric hypercalcemia), apalagi
kalo pasien ga ada riwayat bedah paratiroid. Penilaian rasio calcium-creatinin
clearance (calculated as urine calcium/serum calcium divided by urine
creatinine/serum creatinine) <0.01 is suggestive o FHH, terutama jika ada riwayat
keluarga hiperkalsemia ringan, and generally >0.02 in patients with PHPT. Tambahan
pemeriksaan :
• sequence analysis o the CaSR gene
• PTHrP level
• Serum 1,25(OH)2D levels are increased in granulomatous disorders
 Menentukan kadar kasium serum
Harus tahu kadar kalsiumnya, dan harus diperhitungkan juga konsentrasi
albumin karena 50% kalsium yang ada pada CES dalam keadaan terikat
oleh albumin dan 50% sisanya dalam keadaan terionisasi. Jadi untuk
mengukur kalsium CES harus menghitung kalsium total dan perhatikan
kadar albumin. Jika kadar albumin turun 1 g/dL maka kita harus
menambahkan 0,8 mg/dL dari total kalsium, dan begitu pula kebalikannya
jika kadar albumin naik maka total kalsium harus diturunkan.

Reference value of albumin = 4,1 g/dL

Riwayat penyakit pasien. Jika hiperkalsemia kronik maka kemungkinan

! besar penyebabnya adalah hiperparatiroidisme primer. Tanyakan juga

apakah ada riwayat bedah di leher, riwayat pengobatan, dan riwayat gejala
sistemik yang dapat mengarahkan ke penyakit sarcoidosis atau limfoma.
99mTechne
tium-
labeled Neck
sestamibi ultrasound

99mTechnetium-labeled sestamibi has more than 80% sensitivity for the detection of
hypercellular parathyroid glands, and when it is used in conjunction with SPECT, it has
particular utility in identifying ectopic tumors. Neck ultrasound is often complementary
and has a sensitivity of 75% in experienced centers.

• MRI and CT scans and invasive localizing studies, including highly selective venous catheterization for PTH, and FNAB of suspected
parathyroid masses and arteriograms are generally only used in cases of recurrent or persistent hyperparathyroidism.
• More recently, 4-D CT scans have shown tremendous utility in localizing parathyroid tumors with excellent anatomic detail
 Patients with classic symptoms and metabolic complications related to PHPT are
generally treated by parathyroidectomy

Consensus Conference, asymptomatic PHPT was defined as, "the absence of common
symptoms and signs of PHPT, including no bone, renal, gastrointestinal or
neuromuscular disorders. " Nonoperative management was recommended in this
group of patients with calcium levels 􀐂 1 2 mg/dL, based on several observational
studies that suggested stabiliry with respect to serum calcium, kidney stones, bone
loss, and renal function with time. Parathyroidectomy was recommended for
asymptomatic patients <50 years of age and in cerrain other patients
 In addition, parathyroidectomy has been associated with improved survival (in both
asymptomatic and symptOmatic patients), is more cost-effective than lifelong follow-
up, and is successful in 95% of patients with a minimal (< 1 o/o) complication rate.

Although bisphosphonates and calcimimetics show promise in the treatment of

patients with PHPT, further studies are needed prior to recommending their routine
use in this setting. Therefore, most clinicians recommend parathyroidectomy (by
surgeons experienced in the procedure) for patients with PHPT, except in those
patients where operative risks are prohibitively high
DAFTAR PUSTAKA