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Department of Anesthesiology - Residents Section

Anesthesia Knowledge - Hyperparathyroidism

Hyperparathyroidism

Causes:

  • adenoma (90%)
  • hyperplasia (9%)
  • carcinoma (1%)

» High morbidity during pregnancy: placenta allows accumulation of calcium in the fetus with fetal hypercalcemia and hypoparathyroidism

Symptoms:

  • nephrolithiasis
  • polyuria/polydipsia
  • bone demineralization and subperiostal resorption
  • peptic ulcers
  • weakness, easy fatigability
  • depression, memory loss, psychosis

EKG:

  • prolongation of PR-interval/widening of QRS progressing to blocks
  • bradycardia

Preoperative considerations:

  • correction of intravascular volume: NS (rehydration alone can lower Ca by 2mg/dl)
  • Lasix (not HCTZ which will lead to an increase in calcium)
  • Correction of hypophosphatemia (controversial because of risk of risk of crystallization)

» emergency reduction of Ca is necessary when it exceeds 15mg/dl

  • biphosphonates: inhibition of osteaclastic activity
  • mithramycin: cytotoxic agent with inhibitory effect on osteoclastic activity (lowers Ca by 2mg/dl within 24-48 hours)
  • calcitonin: rapid onset of action (2-4mg/dl) but development of tolerance within 24 hours
  • steroids: only in certain malignancies, vitamin D intoxication, NOT useful in primary hyperparathyroidism
  • dialysis

Intraoperative considerations:

  • unpredictable response to Muscle relaxants, conservative approach recommended
  • increased requirement for nondepolarizers