Hyperparathyroidism

• 252.0 Hyperparathyroidism
• 252.00 Hyperparathyroidism, unspecified
• 252.01 Primary hyperparathyroidism
• 252.08 Other hyperparathyroidism
• 252.02 Secondary hyperparathyroidism, non-renal
• 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

• Index Line 39663 Hyperperistalsis
• Index Line 39781 Hyperproteinemia
• Index Line 52101 Myopathy > in (due to) > hyperparathyroidism NEC
• Index Line 39656 Hyperparathyroidism
• Index Line 39657 Hyperparathyroidism > primary
• Index Line 39658 Hyperparathyroidism > secondary (renal)
• Index Line 39660 Hyperparathyroidism > specified NEC
• Index Line 39661 Hyperparathyroidism > tertiary
• 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

• 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

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 hyperphospatemia
• 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 disease causing low levels of calcium in the body
  • Chromic renal insufficiency
  • Calcium malabsorption
  • Osteomalacia
• Tertiary hyperparathyroidism
  • Glandular hyperfunction and hypersecretion even after correction of abnormality
  • Caused by chronic renal failure
• Quartary hyperthyroidism
  • After surgical removal of primary hyperparathyroidism
• Familial hypocalciuric hypercalcemia (FHH)
  • Autosomal inheritance

Essentials of Diagnosis

• Usually diagnosed before symptoms occur via complete blood count (CBC) test
• Elevated calcium in the blood
• Elevated parathyroid hormone
• Decreased phosphorus in the blood
• Vitamin D deficiency

General Considerations

• May cause pathology in multiple organ systems
  • Gastrointestinal (GI): liver
  • Cardiovascular: heart, peripheral circulation, blood pressure
  • Integument
• Decreased calcium in the bones
• May result in secondary problems such as aerobic capacity and muscle endurance impairment, sarcopenia, weakness/impaired muscle performance, musculoskeletal problems, neuromuscular problems, indicating the need for physical therapy intervention depending on severity

Demographics

• Primary type in adults: 1:1,000 in the Unites States2
• More common in individuals with Columbia descent
• More common over age 50
• More common in females after menopause2

Signs and Symptoms

• Signs and symptoms of primary hyperparathyroidism
• Osteoporosis/osteomalacia
• Kidney stones
• Hypertension
• Urinary tract infections (UTIs)
• Blood in urine
• Excessive urination
• Abdominal pain
...