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Diagnosis, Prognosis And Medical Treatment Of Hyperparathyroidism
Diagnosis And prognosis
Primary hyperparathyroidism should be suspected in all cases of hypercalcemia, recurrent renal calculi, osteitis fibrosa, peptic ulcer, pancreatitis, myopathy, chondrocalcinosis or vague constitutional symptoms. The diagnosis is confirmed by the presence of hypercalcemia and hypophosphatemia. Serum alkaline phosphatase and urinary hydroxyproline excretion are elevated. Urinary c-AMP excretion is elevated. Parathyroid hormone can be assayed by RIA.
Demonstration of the tumour or hyperplasia: Pre-operatively, the parathyroid glands can be demonstrated by barium swallow, radioactive selenomethionine scan, arteriography, thermography, ultrasonography, CT scan, and selective sampling of venous blood from the neck and mediastinum.
The course of hyperparathyroidism tends to be progressive. If detected and treated early, the condition subsides. Skeletal changes revert to normal. Advanced renal lesions fall to clear up and, therefore, it is essential to start treatment before renal damage is established.
Surgical Removal Of Adenoma
Post Operative Tetany
Surgical removal of the adenoma is the treatment of choice. In the case of hyperplasia, all the glands are removed except for a portion of one gland which is left behind. All cases should be investigated for multiple endocrine neoplasia and appropriate treatment is indicated if this is detected. Serum calcium level above 11mg/dl, evidence of bone disease, recurrent renal stones, reduction of glomerular filtration rate below 60 ml/minute and uncontrollable peptic ulcers are indications for early surgery. After successful parathyroidectomy, the serum calcium falls to normal within 24- 48 hours. This does not happen If surgical removal is inadequate. Some cases develop postoperative tetany due to hypocalcemia. This is managed by giving intravenous infusions of calcium gluconate or calcium chloride (1 mg/ml of fluid), the total dose and duration of therapy being decided by clinical progress. If hypocalcemia tends to persist, it is managed on the lines indicated for hypoparathyroidism.
At times, magnesium deficiency may be the cause of postoperative tetany. Serum magnesium levels are low (normal values 1.5- 2.5 meg/liter or 2- 3 mg/dl). Mild cases respond to oral supplementation with magnesium chloride. In severe cases, magnesium sulphate can be given intramuscularly repeatedly or as intravenous infusion lasting for 8- 12 hours. The total dose is decided by the serum magnesium levels. A severe case may require 2 meq/Kg body weight. Magnesium sulphate is available as 20% solution or 50% solution. Parenteral magnesium therapy should be closely monitored, since serum levels above 4 meq/liter lead to neuromuscular paralysis.
© 2014 Funom Theophilus Makama