MetroHealthAnesthesiaAnesthesia and Hyperparathryroidism

Clinical Manifestations
    Etiology
    • Primary hyperparathyroidism
        adenoma
        carcinoma
        hyperplasia of the parathyroid gland
    • Secondary hyperparathyroidism
        renal failure
        intestinal malabsorption sydromes
    • Ectopic hyperparathyroidism
        tumors outside the parathyroid gland
          parathyroid hormone-related peptide
          hepatoma
          bronchogenic carcinoma
    Manifestations (of hypercalcemia)
      Cardiovascular
        hypertension
        ventricular dysrhythmias
        ECG changes (shortened QT interval; or prolonged QT if Ca > 16 mg%)
      Renal
        impaired concentrating ability
        hyperchloremic metabolic acidosis
        polyuria
        dehydration
        polydipsia
        renal stones
        renal failure
      Gastrointestinal
        ileus
        nausea and vomiting
        peptic ulcer disease
        pancreatitis
      Musculoskeletal
        muscle weakness
        osteoporosis
      Neurologic
        delirium
        psychosis
        coma
    Other causes of hypercalcemia
      bone metastases
      vitamin D intoxication
      milk-alkali syndrome
      sarcoidosis
      prolonged immobilization
Anesthetic Considerations
Preoperative
    Assess volume status
    NS and furosemide as needed to decrease serum calcium to acceptable levels (< 14 mg% = 7 mEq/L)
    Rarely, need more aggressive therapy:
    • intravenous biphosphonates
        pamidronate (Aredia)
        etridronate (Didronel)
    • plicamycin (Mithramycin)
    • glucocorticoids
    • calcitonin
    • dialysis
Intraoperative
    Hydrate well to minimize induction hypotension
    Avoid hypoventilation acidosis (increases ionized calcium level)
    Cardiac dysrhythmias
    Osteoporosis
Postoperative


Send Comments to Greg Gordon MD, gjg@po.cwru.edu
Department of Anesthesiology
The MetroHealth System
2500 MetroHealth Drive
Cleveland, Ohio 44109-1998
Phone: (216) 778-4801
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