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26: HYPERPARATHYROIDISM

Debra F. Stern, DPT, DBA, MSM, PT; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYM

  • Primary Hyperparathyroidism

ICD-9-CM CODES

  • 252.0 Hyperparathyroidism

  • 252.00 Hyperparathyroidism, unspecified

  • 252.01 Primary hyperparathyroidism

  • 252.08 Other hyperparathyroidism

  • 252.02 Secondary hyperparathyroidism, nonrenal

  • 588.81 Secondary hyperparathyroidism (of renal origin)

  • Associated ICD-9-CM PT diagnoses/treatment diagnoses that may be directly related

    • 315.4 Developmental coordination disorder

    • 718.45 Contracture of joint, pelvic region and thigh

    • 719.70 Difficulty in walking involving joint site unspecified

    • 728.2 Muscular wasting and disuse atrophy not elsewhere classified

    • 728.89 Other disorders of muscle, ligament, and fascia

    • 729.9 Other and unspecified disorders of soft tissue

    • 780.7 Malaise and fatigue

    • 781.2 Abnormality of gait

    • 782.3 Edema

    • 786.0 Dyspnea and respiratory abnormalities

    • 786.05 Shortness of breath

FIGURE 26-1

Skeletal changes of hyperparathyroidism. A. Subperiosteal resorption of the phalanges and calcification of the digital arteries. B. Erosion of the distal clavicle and soft tissue calcification. C. “Rugger jersey” spine. (From Imboden J, Hellmann DB, Stone JH. Current Rheumatology Diagnosis & Treatment. 2nd ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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ICD-10-CM CODES

  • E21 Hyperparathyroidism and other disorders of parathyroid gland

  • E21.0 Primary hyperparathyroidism

  • E21.1 Secondary hyperparathyroidism, not elsewhere classified

  • E21.2 Other hyperparathyroidism

  • E21.3 Hyperparathyroidism, unspecified

  • N25.81 Secondary hyperparathyroidism of renal origin

  • R19.2 Hyperperistalsis

PREFERRED PRACTICE PATTERNS1

  • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

  • 6B: Impaired Aerobic Capacity/Endurance Associated with Deconditioning

PATIENT PRESENTATION

A 66-year-old male referred to physical therapy with cervical pain. In his history, he stated that he was recently diagnosed with low Vitamin D and was put on a supplement. His doctor told him his circulating calcium levels were a bit elevated, but that he was not concerned and would check it again in 6 months. He complains of some mild loss of appetite, but is happy about it because he needs to lose a few pounds. Most surprising to him was when his bone density was tested at a recent health fair and he was told he had osteopenia. He also complains of recent onset of constipation. Cervical assessment demonstrated mild limitation in ROM and muscles pulling especially with forward flexion. In addition, when actively forward flexing, he described feeling like “maybe there was lump in his throat.”

KEY FEATURES

Description

  • Excess of systemic hyperparathyroid hormone (PTH) (hypersecretion) from one or more of the four parathyroid glands

    • Hormone regulates calcium in the bloodstream, producing hypercalcemia and hyperphosphatemia

  • May be primary or secondary to another disease process

  • Primary hyperparathyroidism (HPT) (most common)

    • Enlargement of one of the glands

    • Excess production of the hormone

    • Increased calcium in the blood/hypercalcemia

  • Secondary hyperthyroidism

    • Secondary ...

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