parathyroid glands, characterized past times decalcification of os in addition to the formation of kidney stones, which comprise calcium. Hyperparathyroidism is divided into two, namely primary in addition to secondary hyperparathyroidism. Primary hyperparathyroidism occurs 2 or 3 times to a greater extent than oftentimes inwards women than men in addition to inwards patients aged 60-70 years. While secondary hyperparathyroidism amongst manifestations like to patients amongst chronic renal failure. Renal rickets, caused past times memory of phosphorus volition increment the stimulation of the parathyroid glands in addition to increased secretion of parathyroid hormone. (Brunner & Suddath, 2001)
Hyperparathyroidism is a grapheme of a illness caused past times excess secretion of parathyroid hormone, amino acid polypeptide hormone. Secretion of parathyroid hormone is straight regulated past times the concentration of calcium ion fluid. The major number of parathyroid hormone is increased past times increasing the concentration of liquid calcium in addition to phosphate calcium unloosen from os matrix, increases the absorption of calcium past times the kidneys, in addition to the kidneys to increment production. Parathyroid hormone besides causes phosphaturia, if dehydrated phosphate. Hyperparathyroidism is ordinarily divided into primary, secondary in addition to tertiary. (Lawrence Kim, MD, 2005, department 2).
Etiology of Hyperparathyroidism
According to Lawrence Kim, MD. 2005, the etiology of hyperparathyroidism are:
Hyperparathyroidism tin live primary (ie caused past times hyperplasia or parathyroid neoplasm) or secondary, where cases are ordinarily associated amongst chronic renal failure.
In 80% of cases of primary hyperparathyroidism caused past times parathyroid adenomas are benign; 18% of cases caused past times hyperplasia of the parathyroid glands: in addition to 2% of cases are caused past times parathyroid carcinoma (damjanov, 1996). Normally at that topographic point are iv parathyroid glands. Parathyroid adenoma or carcinoma is characterized past times enlargement of the gland, amongst the other glands remained normal. In parathyroid hyperplasia, iv enlarged glands. Because the diagnosis of adenoma or hyperplasia tin non live enforced preoperative, in addition to so it is of import for the surgeon to examine the iv gland.
If 1 identified an enlarged adenomatous gland, the gland is ordinarily removed in addition to others left intact. If it is an enlarged lymph quaternary surgeon volition elevator the 3rd in addition to larn out 1 lymph gland that should live sufficient to hold the homeostasis of calcium-phosphate.
Secondary parathyroid hyperplasia tin live distinguished from primary hyperplasia, because the iv symmetrically enlarged glands. Enlarged parathyroid glands in addition to hiperfungsi are compensatory mechanisms that are triggered past times the memory of the format in addition to hypercalcemia associated amongst chronic kidney disease. Osteomalacia caused past times hipovitaminosis D, equally inwards rickets, tin Pb to the same effect.
Hyperparathyroidism is characterized past times excess PTH inwards the circulation. PTH mainly working on os in addition to kidney. In bone, PTH increases calcium resorption from the renal tubules Limen. Thereby reducing the excretion of calcium inwards urine. PTH besides increases the active bird of vitamin D3 inwards the kidneys, which inwards plough facilitates the uptake of calcium from nutrient inwards the intestines. Hypercalcemia in addition to hypophosphatemia therefore compensatory, is abnormlitas biochemical detected through blood analysis. Serum PTH concentrations besides increased. (Rumahorbor, Hotma, 1999)
Excess production of parathyroid hormone is accompanied past times kidney failure tin crusade a broad hit of os disease, which oftentimes occurs tulng is osteitis fibrosa cystica, a illness of increased os resorption due to increased levels of parathyroid hormone. Other os diseases are besides mutual inwards these patients, precisely did non look inwards person. (Lawrence Kim, MD, 2005, department 5)
Excess amounts of PTH secretion causes hypercalcemia tin crusade direct effects on receptors inwards bone, intestinal tract, in addition to kidneys. Physiologically PTH secretion is inhibited past times high serum calcium ions. The machinery is non active inwards the reason of adenomas, or gland hyperplasia, hypersecretion of PTH which coincides amongst hypercalcemia. Reabsorption of calcium from os in addition to increased absorption from the gut is a direct number of the increment inwards PTH.
At the fourth dimension of serum calcium levels approaching 12 mg / dL, renal tubular reabsorption of calcium causing excessive hypercalciuria circumstances. This tin increment the incidence nefrolithiasis, which raises tin decreased creatinine clearance in addition to renal failure. Elevated levels of extracellular calcium tin live deposited on soft tissue. The pain arises due to calcified nodules bird on the skin, subcutaneous tissues, tendons (calcific tendonitis), in addition to cartilage (chondrocalcinosis). Vitamin D plays an of import role inwards calcium metabolism past times PTH causes needed to piece of occupation inwards the target organ.
Clinical Manifestations of Hyperparathyroidism
Patients may non be, or receive got signs in addition to symptoms due to the disruption of multiple organ systems. Symptoms of apathy, fatigue complaints, musculus weakness, nausea, vomiting, constipation, hypertension, in addition to cardiac arrhythmias may occur: all this is related to elevated levels of calcium inwards the blood. Psychological manifestations may hit from irritability in addition to emotional reason of neurosis to psychosis caused past times the direct number of calcium on the encephalon in addition to nervous system. Increased calcium levels volition decrease the potential excitation of nervus in addition to musculus tissue.
Stone formation inwards 1 or both kidneys associated amongst increased excretion of calcium in addition to phosphorus is 1 of the complications of primary hyperparathyroidism. Kidney harm caused past times atmospheric precipitation of calcium phosphate inwards the pelvis, in addition to renal parenchyma resulting inwards kidney stones (renal calculi), obstruction, pyelonephritis in addition to renal failure.
Musculoskeletal symptoms accompanying hyperparathyroidism may tumble out due to demineralization of os or os tumors, which appears inwards the bird of benign giant cells due to excessive osteoclast growth. Patients may sense skeletal hurting in addition to tenderness, particularly inwards the dorsum in addition to joints; hurting when supporting the body; pathologic fractures; deformity, in addition to shortening of the body. Bone loss associated amongst hyperparathyroidism is a direct chances constituent for fracture.
The incidence of peptic ulcer in addition to prankreatitis increased inwards hyperparathyroidism in addition to tin crusade symptoms gastroitestinal. (Brunner & Suddath, 2001) Sumber http://nanda-nursinginterventions.blogspot.com/
Hyperparathyroidism is a grapheme of a illness caused past times excess secretion of parathyroid hormone, amino acid polypeptide hormone. Secretion of parathyroid hormone is straight regulated past times the concentration of calcium ion fluid. The major number of parathyroid hormone is increased past times increasing the concentration of liquid calcium in addition to phosphate calcium unloosen from os matrix, increases the absorption of calcium past times the kidneys, in addition to the kidneys to increment production. Parathyroid hormone besides causes phosphaturia, if dehydrated phosphate. Hyperparathyroidism is ordinarily divided into primary, secondary in addition to tertiary. (Lawrence Kim, MD, 2005, department 2).
Etiology of Hyperparathyroidism
According to Lawrence Kim, MD. 2005, the etiology of hyperparathyroidism are:
- Approximately 85% of cases of primary hyperparathyroidism caused past times unmarried adenoma.
- While the other 15% involves diverse glands (eg diverse adenoma or hyperplasia). Usually hereditary in addition to frequency associated amongst other endocrine disorders.
- Few cases of primary hyperparathyroidism caused past times parathyroid carcinoma. Etiology of adenoma in addition to hyperplasia inwards most cases unknown. Family cases tin tumble out either equally component of diverse endocrine neoplasia syndrome, hyperparathyroidism tumor syndrome, or hyperparathyroidism derivatives. Familial hypercalcemia in addition to hypocalcuric in addition to neonatal severe hyperparathyroidism are besides included into this category.
- Some surgeons in addition to pathologist reported that enlargement of the gland adenoma types are mostly multiple doubles. In near 15% of patients amongst hyper-function of all glands; primary jail mobile telephone parathyroid hyperplasia.
Hyperparathyroidism tin live primary (ie caused past times hyperplasia or parathyroid neoplasm) or secondary, where cases are ordinarily associated amongst chronic renal failure.
In 80% of cases of primary hyperparathyroidism caused past times parathyroid adenomas are benign; 18% of cases caused past times hyperplasia of the parathyroid glands: in addition to 2% of cases are caused past times parathyroid carcinoma (damjanov, 1996). Normally at that topographic point are iv parathyroid glands. Parathyroid adenoma or carcinoma is characterized past times enlargement of the gland, amongst the other glands remained normal. In parathyroid hyperplasia, iv enlarged glands. Because the diagnosis of adenoma or hyperplasia tin non live enforced preoperative, in addition to so it is of import for the surgeon to examine the iv gland.
If 1 identified an enlarged adenomatous gland, the gland is ordinarily removed in addition to others left intact. If it is an enlarged lymph quaternary surgeon volition elevator the 3rd in addition to larn out 1 lymph gland that should live sufficient to hold the homeostasis of calcium-phosphate.
Secondary parathyroid hyperplasia tin live distinguished from primary hyperplasia, because the iv symmetrically enlarged glands. Enlarged parathyroid glands in addition to hiperfungsi are compensatory mechanisms that are triggered past times the memory of the format in addition to hypercalcemia associated amongst chronic kidney disease. Osteomalacia caused past times hipovitaminosis D, equally inwards rickets, tin Pb to the same effect.
Hyperparathyroidism is characterized past times excess PTH inwards the circulation. PTH mainly working on os in addition to kidney. In bone, PTH increases calcium resorption from the renal tubules Limen. Thereby reducing the excretion of calcium inwards urine. PTH besides increases the active bird of vitamin D3 inwards the kidneys, which inwards plough facilitates the uptake of calcium from nutrient inwards the intestines. Hypercalcemia in addition to hypophosphatemia therefore compensatory, is abnormlitas biochemical detected through blood analysis. Serum PTH concentrations besides increased. (Rumahorbor, Hotma, 1999)
Excess production of parathyroid hormone is accompanied past times kidney failure tin crusade a broad hit of os disease, which oftentimes occurs tulng is osteitis fibrosa cystica, a illness of increased os resorption due to increased levels of parathyroid hormone. Other os diseases are besides mutual inwards these patients, precisely did non look inwards person. (Lawrence Kim, MD, 2005, department 5)
Excess amounts of PTH secretion causes hypercalcemia tin crusade direct effects on receptors inwards bone, intestinal tract, in addition to kidneys. Physiologically PTH secretion is inhibited past times high serum calcium ions. The machinery is non active inwards the reason of adenomas, or gland hyperplasia, hypersecretion of PTH which coincides amongst hypercalcemia. Reabsorption of calcium from os in addition to increased absorption from the gut is a direct number of the increment inwards PTH.
At the fourth dimension of serum calcium levels approaching 12 mg / dL, renal tubular reabsorption of calcium causing excessive hypercalciuria circumstances. This tin increment the incidence nefrolithiasis, which raises tin decreased creatinine clearance in addition to renal failure. Elevated levels of extracellular calcium tin live deposited on soft tissue. The pain arises due to calcified nodules bird on the skin, subcutaneous tissues, tendons (calcific tendonitis), in addition to cartilage (chondrocalcinosis). Vitamin D plays an of import role inwards calcium metabolism past times PTH causes needed to piece of occupation inwards the target organ.
Clinical Manifestations of Hyperparathyroidism
Patients may non be, or receive got signs in addition to symptoms due to the disruption of multiple organ systems. Symptoms of apathy, fatigue complaints, musculus weakness, nausea, vomiting, constipation, hypertension, in addition to cardiac arrhythmias may occur: all this is related to elevated levels of calcium inwards the blood. Psychological manifestations may hit from irritability in addition to emotional reason of neurosis to psychosis caused past times the direct number of calcium on the encephalon in addition to nervous system. Increased calcium levels volition decrease the potential excitation of nervus in addition to musculus tissue.
Stone formation inwards 1 or both kidneys associated amongst increased excretion of calcium in addition to phosphorus is 1 of the complications of primary hyperparathyroidism. Kidney harm caused past times atmospheric precipitation of calcium phosphate inwards the pelvis, in addition to renal parenchyma resulting inwards kidney stones (renal calculi), obstruction, pyelonephritis in addition to renal failure.
Musculoskeletal symptoms accompanying hyperparathyroidism may tumble out due to demineralization of os or os tumors, which appears inwards the bird of benign giant cells due to excessive osteoclast growth. Patients may sense skeletal hurting in addition to tenderness, particularly inwards the dorsum in addition to joints; hurting when supporting the body; pathologic fractures; deformity, in addition to shortening of the body. Bone loss associated amongst hyperparathyroidism is a direct chances constituent for fracture.
The incidence of peptic ulcer in addition to prankreatitis increased inwards hyperparathyroidism in addition to tin crusade symptoms gastroitestinal. (Brunner & Suddath, 2001) Sumber http://nanda-nursinginterventions.blogspot.com/