PART V: FOLLOW-UP MANAGEMENT

HYPERPARATHYROIDISM

PART V: FOLLOW-UP MANAGEMENT
Kathryn P. Bongcawil, RN
Fatima Nur-Hayda V. Malali, RN
Jerrick Y. Medalla, RN


Kidney transplantation and Oral calcitriol may be effective f0llow-up management for increased parathyroid hormone production. This is a result of of a study about a patient with Brown Tumor (a form of hyperparathyriod bone disease) since progress is noted on the patient after three years of transplant and intake of this medication.1

A study concluded that total Surgical Parathyroidectomy has a high rate rate for cure of the Secondary Parathyrodism. It was considered to be safe and manageable. This is the result of the authors observation of patients who underwent this procedure without autotransplantation. Only a minimal percentage had recurrence, some with supernumary glands noted. A number of the subjects had transplant of the kidneys and among these patients uncomplicated hypocalcemia was noted.2

Following removal of the adenoma, Calcim level goes back to normal. Upon evaluation, patients should exhibit neither tiredness or pains in joints and bones, or even mental changes. Patients are also evidently less depressed and pruritus is reduced. CT Scan and ablation of tumors with alcohol may be beneficial to elderly who cannot tolerate local or general anesthesia.3

After Surgery, healing, voice quality, and laboratory studies should be looked into. Calcium should be low 24 to 36 hours after operation and Parathyroid Hormone becomes normal within 30 hours. Low calcium diet should be reinforced. Serum Calcium and Creatinine should be measured with annual Bone Density Examination. The patients should have their Bone Mineral Density evaluated one year after Parathyroidectomy.4,5

Bilateral exploration is essential to gauze the success of the Parathyroidectomy once Calcium and Parathyroid Hormone levels are note. There is a need to have follow-up check-ups from an Endocrinologist following surgery.5

After parathyroidectomy a successful surgical management of primary hyperparathyroidism has required bilateral exploration of the neck. By confirming complete removal of hypersecreting tissue, an intraoperative parathyroid hormone (IO-PTH) assay allows use of a more limited procedure. (C. Nelson, PhD, CLS and N.Victor, MD).6

The study of M.Bolland, and A. Grey proposed that postmenopausal women who have hormone replacement therapy is sufficient enough to control the said diseases rather than the Surgical Management. There were few clinical events potentially related to primary hyperparathyroidism during the follow-up period and only three women had parathyroidectomy performed. In those women who were initially assigned to placebo treatment, the annual change in bone mineral density was similar to that observed in eucalcaemic controls at the spine and total body but there was greater loss of bone mineral density at the femoral neck.7

While controversy on parathyroidectomy rises another study showed Conservative management of primary hyperparathyroidism is not an unreasonable option, and patients who do not have symptoms need not necessarily be pressed to accept surgery. (C.PATERSON, J BURNS. BRITISH MEDICAL JOURNAL VOLUME 289 10 NOVEMBER 1984). 8 This study was supported by S. SILVERBERG M.D., the Massachusetts Medical Society with asymptomatic PHPT do not develop symptoms or complications of PHPT, and their biochemical parameters remains stable. Therefore, such asymptomatic women with PHPT can often be managed conservatively without parathyroidectomy, but approximately one quarter of them did have some progression. (N Engl J Med 1999;341:1249-55.)9

On the other hand another study rejected this by K. Sejean1, S. Calmus(European Journal of Endocrinology 2005) Surgery is more effective than medical follow-up at a reasonable cost and can be preferred except in patients choosing medical follow-up. Minimally invasive surgery is cost-effective compared to the traditional surgical approach.10


Referrence:

1 Spasovski, G., Masin-Spasovska, J., Gjurchinov, D.() Successful Treatment of Severe Secondary Hyperparathyroidism (Brown TUmor) by Kidney transplantation and pulses of oral calcitriol. Clinical Transplant 2009 Jun-Jul; 23(3): 426-30

2 Stracke, S., Keller, F., Steinbach, G., Henne-Burns, D., WUel, P. (2009). Long-Term Outcome after Total Parathyroidectomy for the Management of Secondary Hyperparathyroidism. Nephron Clinical Practice 2009; 111:c102-c109. Doi: 10.1159/000191200

3 LaBagnara, J. (2009). Hypeparathyroidism: Follow-up. Retrived from: http://emedicine.medscape.com/article/849233-followup

4 http://bestpractice.bmj.com/best-practice/monograph/133/follow-up.html

5 Overholt, M. (1994). Primary Hyperparathyroidism. Baylor College of Medicine. Retrieved from http://www.bcm.edu/oto/grand/12094.html.

6 C. Nelson, PhD, CLS and N.Victor, MD“Rapid Intraoperative Parathyroid Hormone Assay in the Surgical Management of Hyperparathyroidism” The Permanente Journal/ Winter 2007/ Volume 11 No. 1

7 M.Bolland, and A. Grey “Prospective 10-year study of postmenopausal women with asymptomatic primary hyperparathyroidism” Journal of the New Zealand Medical Association, 04-July-2008, Vol 121 No 1277

8 C.PATERSON, J BURNS. BRITISH MEDICAL JOURNAL VOLUME 289 10 NOVEMBER 1984

9 S. SILVERBERG M.D “A 10-YEAR PROSPECTIVE STUDY OF PRIMARY HYPERPARATHYROIDISM WITH OR WITHOUT PARATHYROID SURGERY” in Massachusetts Medical Society

10 K. Sejean1, S. Calmus. Surgery versus medical follow-up in patients with asymptomatic primary hyperparathyroidism: a decision analysisEuropean Journal of Endocrinology 2005