EAQ Med-Surg Chapter 63 (Parathyroid)

Which symptom is usually present with mild to moderate hypocalcemia? - Seizures - Numbness - Incontinence - Muscle cramps

- Numbness Numbness around the mouth or in the hands and feet is associated with mild to moderate hypocalcemia. The other options are associated with more severe hypocalcemia.

A nurse is caring for a patient with hyperparathyroidism. Which lab finding indicates a high risk of psychosis? - Serum calcium 15 mg/dL - Serum phosphorous 3.1 mg/dL - Serum magnesium 2.1 mEq/L - Serum parathyroid hormone 60 pg/mL

- Serum calcium 15 mg/dL The normal serum calcium concentration ranges from 8.5 to 10.2 mg/dL. A serum calcium level greater than 12 mg/dL indicates that the patient is at a high risk for psychosis. The normal serum concentration of phosphorous ranges from 3.0 to 4.5 mg/dL, so a value of 3.1 mg/dL is normal. The normal serum concentration of magnesium ranges from 1.3 to 2.1 mEq/L, so a value of 2.1 mEq/L is normal. The normal concentration of PTH ranges from 10 to 65 pg/mL, so a value of 60 pg/mL is normal.

What is a cause of hyperparathyroidism? - Sepsis - Hypomagnesemia - Vitamin D deficiency - Chronic bladder disease

- Vitamin D deficiency Hyperparathyroidism can be caused by vitamin D deficiency. Sepsis is not a cause of parathyroid disorders. Hypomagnesemia is a cause of hypoparathyroidism. Chronic bladder disease does not cause parathyroid disorders.

A patient is suspected of having hyperparathyroidism. Which treatment strategy would be therapeutically effective in this patient? - Calcitonin - Furosemide - IV phosphates - Calcitonin with glucocorticoids

- Calcitonin with glucocorticoids Calcitonin decreases the release of skeletal calcium and increases the kidney excretion of calcium. The therapeutic effects of calcitonin are greatly enhanced if it is given along with glucocorticoids. It is not effective when used alone because of its short duration of action. Furosemide is used in reducing serum calcium levels in patients who have a milder disease. IV phosphates are used only when the serum calcium levels need to be lowered rapidly.

What is the treatment modality for acute vitamin D deficiency? - Calcium chloride 10% - Calcitriol 0.5 - 2 mg daily - Ergocalciferol oral 50,000 - 400,000 units daily - Magnesium sulfate 2 mL doses daily IV

- Calcitriol 0.5 - 2 mg daily Acute vitamin D deficiency is treated with oral calcitriol, 0.5 - 2 mg daily. In acute and severe hypocalcemia, IV calcium is given as a 10% solution of calcium chloride or calcium gluconate over 10-15 minutes. Long term therapy for vitamin D deficiency is 50,000-400,000 units of oral ergocalciferol daily. Acute hypomagnesemia is corrected with 50% magnesium sulfate in 2 mL doses (up to 4 g daily) IV.

Upon reviewing the medical reports of a patient with hypoparathyroidism, the nurse notices the serum calcium level as 8 mg/dL. What would be the appropriate long-term therapy in this patient? - Calcium - Calcitriol - Calcitonin - Cinacalcet

- Calcium In hypoparathyroidism, serum calcium levels are decreased. Thus, the daily oral intake of 0.5 - 2 mg calcium is prescribed to manage hypocalcemia. Calcitriol is used to correct vitamin D deficiency. Calcitonin is preferred in patients with hyperparathyroidism. Cinacalcet is used to treat hypercalcemia related to parathyroid cancer.

What are the parathyroid glands responsible for maintaining? - Iodine and iron balance - Calcium and iodine balance - Sodium and electrolyte balance - Calcium and phosphate balance

- Calcium and phosphate balance The parathyroid glands maintain calcium and phosphate balance. They do not maintain the balance of iodine, iron, sodium, or electrolytes.

What is the consequence of the action of the parathyroid hormone on the kidneys? - Calcium excretion and phosphorous excretion - Calcium reabsorption and phosphorous excretion - Calcium excretion and phosphorous reabsorption - Calcium reabsorption phosphorous reabsorption

- Calcium reabsorption and phosphorous excretion The parathyroid glands maintain calcium and phosphate balance. Parathyroid hormone (PTH), parathormone, or parathyrin is secreted by the chief cells of the parathyroid glands. PTH acts directly on the kidney, causing reabsorption of calcium and excretion of phosphorous.

What is a common cause of hypoparathyroidism? - Neck trauma - Hypocalcemia - Vitamin K deficiency - Congenital dysgenesis

- Congenital dysgenesis Congenital dysgenesis is one of the common causes of hypoparathyroidism. Neck trauma causes hyperparathyroidism. Hypocalcemia causes CKD. Vitamin K deficiency causes hyperparathyroidism.

What is a common cause of hyperparathyroidism? - Hypercalcemia - Hypomagnesemia - Hypophosphatemia - Congenital hyperplasia

- Congenital hyperplasia Congenital hyperplasia can cause hyperparathyroidism. Hyperparathyroidism causes hypercalcemia and hypophosphatemia. Hypomagnesemia causes hypoparathyroidism.

What is the consequence of the action of parathyroid hormone on the bones? - Increased osteoblastic activity - Unaltered osteoblastic activity - Decreased osteoblastic activity - Decreased osteoclast activity

- Decreased osteoblast activity Parathyroid hormone (PTH) levels increase bone resorption (bone loss of calcium) by decreasing the osteoblastic activity in the bones. The osteoclastic activity is increased, resulting in bone destruction. The osteoblastic activity is not unaltered or decreased, and the osteoclastic activity is not decreased.

The primary health care provider prescribes 400,000 units of oral ergocalciferol to a patient with hypoparathyroidism. Which assessment finding supports the intervention? - Decreased serum calcium levels - Decreased serum vitamin D levels - Decreased serum magnesium levels - Decreased serum phosphorous levels

- Decreased serum vitamin D levels Hypoparathyroidism is characterized by deficiency of calcium, magnesium, and vitamin D. Long-term therapy for vitamin D deficiency is 400,000 units of oral ergocalciferol. Decreased serum calcium levels are treated with IV administration calcium chloride or calcium gluconate. Decreased serum magnesium level is treated with IV administration of magnesium sulfate. Decreased serum phosphorous levels are treated with oral replacement of phosphorous along with a vitamin D supplement.

The nurse teaches a patient with hyperparathyroidism about actions the patient can take to specifically reduce the incidence of renal calculi. Which action by the patient indicates effective learning? - Reduces alcohol ingestion - Drinks large amounts of water and fluids - Includes fiber-containing foods in the diet - Reduces the consumption of caffeinated drinks

- Drinks large amounts of water and fluids The nurse instructs the patient to increase the intake of oral fluids to prevent kidney stones (calculi) that are caused by the excessive secretion of parathyroid hormone. The nurse instructs the patient to reduce alcohol ingestion to promote parathyroid hormone function. The nurse instructs the patient to increase the intake of fiber containing foods to minimize constipation, which may be caused by hypercalcemia. The nurse instructs the patient to reduce the consumption of caffeinated drinks to decrease impaired mentation changes.

A patient had a parathyroidectomy 18 hours ago. Which finding requires immediate attention? - Sore throat - Hoarseness - Pain on moving the head - Edema at the surgical site

- Hoarseness Hoarseness or stridor is an indication of respiratory distress and requires immediate attention. Edema at the surgical site is an expected finding. Pain when the patient moves the head or attempts to lift the head off the bed is an expected finding after a parathyroidectomy. Any time a patient has been intubated for surgery, a sore throat is a common occurrence in the postoperative period. This is especially true for patients who have had surgery involving the neck.

What does hyperparathyroidism cause? - Anemia - Hypercalcemia - Hypernatremia - Hyperphosphatemia

- Hypercalcemia Hyperparathyroidism causes hypercalcemia, which is excessive levels of calcium in the blood. Hyperparathyroidism causes hypercalcemia, which is excessive levels of calcium in the blood. Anemia is low iron. Hypernatremia is excessive sodium. Hyperphosphatemia is excessive phosphorous. Hyperparathyroidism causes hypophosphatemia.

Which condition should the nurse suspect in a patient who has undergone parathyroidectomy? - Hypocalcemia - Hyponatremia - Hypercalcemia - Hypophosphatemia

- Hypocalcemia Excision of the parathyroid gland (parathyroidectomy) leads to hypoparathyroidism. Due to the absence of parathyroid hormone, calcium reabsorption in the kidneys is hindered. This leads to hypocalcemia, which occurs due to a decrease in the serum calcium levels. PTH does not regulate the serum sodium levels. The serum phosphorous level increases in hypoparathyroidism, resulting in hyperphosphatemia.

Which electrolyte disturbance causes hypoparathyroidism? - Hyperkalemia - Hyponatremia - Hypercalcemia - Hypomagnesemia

- Hypomagnesemia Hypomagnesemia is decreased serum magnesium level, which causes impairment of parathyroid hormone secretion. This results in hypoparathyroidism. Hyperkalemia is not a cause. Hyponatremia is seen in patients with impaired thyroid and parathyroid hormone function. Hypercalcemia is characterized by increased serum calcium levels, which are seen in patients with hyperparathyroidism.

What type of parathyroid disorder would the nurse expect to find in patients with chronic kidney disease? - Hypocalcemia - Hypomagnesemia - Hyperparathyroidism - Iatrogenic hypoparathyroidism

- Hypomagnesemia Hypomagnesemia may cause hypoparathyroidism. Hypomagnesemia is seen in patients with CKD, malabsorption syndrome, and malnutrition.

What is the most common form of hypoparathyroidism? - Idiopathic - Iatrogenic - Hypomagnesemia - Hypophosphatemia

- Iatrogenic Iatrogenic hypoparathyroidism is the most common form of hypoparathyroidism and is caused by the removal of all parathyroid tissue during total thyroidectomy or removal of the parathyroid glands themselves. Idiopathic hypoparathyroidism can occur spontaneously, but is not the most common form. Hypomagnesemia is decreased serum magnesium levels, which can cause hypoparathyroidism, but is not a form of it. Hypophosphatemia is not a form of hypoparathyroidism.

What parathyroid disorder is associated with a total thyroidectomy? - Hypercalcemia - Hypomagnesemia - Idiopathic hypoparathyroidism - Iatrogenic hypoparathyroidism

- Iatrogenic hypoparathyroidism Iatrogenic hypoparathyroidism is a parathyroid disorder that is associated with a total thyroidectomy. Hypercalcemia is associated with hyperparathyroidism. Hypomagnesemia is associated with chronic kidney disease, malnutrition, and malabsorption syndrome. Idiopathic hypoparathyroidism is associated with disorders such as adrenal insufficiency, diabetes mellitus, and hypothyroidism.

The nurse knows to assess serum calcium levels for the patient with hyperparathyroidism because of which mechanism? - Increased osteoblastic activity in the bone - Decreased osteoclastic activity in the bone - Increased reabsorption of calcium by the kidneys - Increased reabsorption of phosphate by the kidneys

- Increased reabsorption of calcium by the kidneys Increased levels of PTH cause the kidneys to reabsorb calcium, causing hypercalcemia. Hypercalcemia also occurs if there is decreased osteoblastic activity, or bone production. Similarly, an increased osteoclastic activity, or bone destruction, also causes hypercalcemia. Increased reabsorption of phosphate by the kidneys causes hyperkalemia.

A patient with hyperparathyroidism is prescribed calcitonin with glucocorticoids. How does this drug work to lower serum calcium levels? - It prevents bone resorption - It lowers the levels of free calcium - It interferes with calcium absorption - It reduces the release of skeletal calcium

- It reduces the release of skeletal calcium Calcitonin is a short-acting drug. The therapeutic effect is greatly enhanced when given along with glucocorticoids. Calcitonin decreases the release of skeletal calcium and increases the excretion of calcium by the kidneys. Oral phosphates inhibit bone resorption and interfere with calcium absorption. Calcium chelators, such a mithramycin, lower the calcium level by binding calcium. This reduces the level of free calcium.

An older patient with an elevated serum calcium level is receiving IV furosemide and in infusion of normal saline at 150 mL/hr. Which nursing action can the RN delegate to UAP? - Monitor the patient for SOB. - Ask the patient about any numbness or tingling. - Check for bone deformities in the patient's back. - Measure the patient's intake and output hourly.

- Measure the patient's intake and output hourly. Measuring intake and output is a commonly delegated nursing action that is within the UAP scope of practice. Numbness and tingling is part of the patient assessment that needs to be completed by a licensed nurse. Bony deformities can be due to pathologic fractures; physical assessment is a complex task that cannot be delegated. An older patient receiving an IV at 150 mL/hr is at risk for congestive heart failure; careful monitoring for SOB is the responsibility of the RN.

A patient with hyperparathyroidism is being treated with cinacalcet. The primary health care provider wants the patient to discontinue cinacalcet and begin furosemide. Which condition does the nurse suspect? - Parathyroid carcinoma - Mild hyperparathyroidism - Severe primary hyperparathyroidism - Severe secondary hyperparathyroidism

- Mild hyperparathyroidism Furosemide is the drug of choice for mild hyperparathyroidism. The patient might have had a remission of symptoms, which improved from severe hyperparathyroidism to mild hyperparathyroidism. Therefore, furosemide is chosen to treat the patient. Cinacalcet is the drug of choice in cases of parathyroid carcinoma, severe primary hyperparathyroidism, and secondary hyperparathyroidism.

A patient admitted with hyperparathyroidism has a very high urine output during the previous shift. Of these actions, what does the nurse do next? - Slows the rate of IV fluids - Monitor intake and output - Calls the healthcare provider - Performs an immediate cardiac assessment

- Monitor intake and output Diuretic and hydration therapies are used most often for reducing serum calcium levels in patients with hyperparathyroidism. Usually, a diuretic that increases kidney excretion of calcium is used together with IV saline in large volumes to promote renal calcium excretion. The health care provider does not need to be notified in this situation. Cardiac assessment is part of the nurse's routine evaluation of the patient. Slowing the rate of IV fluids is contraindicated because the patient will become dehydrated because of the use of diuretics to increase kidney excretion of calcium.

The nurse is caring for a patient receiving hydration therapy. What does the nurse expect if there is a sudden drop in calcium levels? - Nausea - Constipation - Epigastric pain - Muscle numbness

- Muscle numbness Mild to moderate hypoglycemia or a sudden drop in calcium levels causes tingling or muscle numbness. The other options are associated with increased levels of serum calcium.

The assessment findings of a patient with a history of radiation therapy to the neck show bone degeneration and electrolyte imbalance. What could be the possible diagnosis? - Thyroid disorder - Pituitary disorder - Pancreatic disorder - Parathyroid disorder

- Parathyroid disorder A patient with a parathyroid will have an electrolyte imbalance. Because of the changes in the serum calcium level, bone density may be affected, and the patient may suffer from bone degeneration. Thyroid disorders are characterized by imbalances in the serum levels of thyroxine hormone. Pituitary disorders are not associated with hormone level imbalances. Pancreatic disorder is characterized by a blood glucose level imbalance.

The primary health care provider prescribes cinacalcet to a patient with hyperparathyroidism; however, the patient failed to respond to the medication. What is the alternative treatment choice for this patient? - Calcitonin - Phosphates - Glucocorticoids - Mineralocorticoids

- Phosphates Cinacalcet is the most preferred drug for a patient with severe manifestations of primary and secondary hyperparathyroidism. For patients who do not respond to cinacalcet, oral and intravenous phosphates are used. Oral phosphates inhibit bone resorption and interfere with calcium absorption. IV phosphates are used only when serum calcium levels need to be lowered rapidly. Calcitonin has a short duration of action, which is not used as an alternative for cinacalcet drug therapy; however, when used along with glucocorticoids, cinacalcet has an increased therapeutic effect. Mineralocorticoids should not be administered to patients with hyperparathyroidism.

What finding during the physical assessment of a patient does the nurse associate with hypoparathyroidism? - Intolerance to heat - Decreased attention span - Presence of bands on the teeth - Wide-eyed or startled appearance

- Presence of bands on the teeth The patient with hypoparathyroidism has bands on the teeth from loss of enamel because of hypocalcemia. The other options align with hyperthyroidism.

What manifestation does the nurse expect to find in a patient with hyperparathyroidism? - Weight gain - Presence of renal calculi - Decreased serum gastrin - Serum calcium less than 9 mg/dL

- Presence of renal calculi X-rays for the patient with hyperparathyroidism how the presence of renal calculi and deposits of calcium in the dost tissue of the kidney because of hypercalcemia. Increased serum levels lead to an elevated serum gastrin level, which leads to peptic ulcer. Serum calcium levels are generally greater than 12 mg/dL. Fatigue and lethargy become more severe as serum calcium levels rise. The patient with high serum calcium levels develops GI problems, such as anorexia, nausea, and weight loss.

What is the nursing priority for a patient with chronic hyperparathyroidism? - Preventing injury - Reducing stimulation - Encouraging exercise - Reducing room temperature

- Preventing injury The nursing priority for a patient with chronic hyperparathyroidism is preventing injury. The patient has loss of bone density and is at risk for pathologic fractures. The nurse does not encourage the patient to exercise because the patient is susceptible to injury.

The nurse is caring for a patient with hypocalcemia due to hypoparathyroidism. What is the cause of iatrogenic hypoparathyroidism? - Chronic kidney disease - Malabsorption syndromes - Low serum magnesium levels - Removal of the parathyroid glands

- Removal of the parathyroid glands Iatrogenic hypoparathyroidism is caused by the removal of all parathyroid tissue during a total thyroidectomy or by deliberate surgical removal of the parathyroid glands. Patients with malabsorption syndromes, malnutrition, and CKD have hypomagnesemia or decreased serum magnesium levels. Hypomagnesemia may also cause hypoparathyroidism.

While assessing a patient with hypoparathyroidism, the nurse observes severe muscle cramps and elbow flexion. Which condition does the nurse suspect? - Severe hypocalcemia - Moderate hypercalcemia - Severe hypomagnesemia - Moderate hyperphosphatemia

- Severe hypocalcemia Severe muscle cramps indicate severe hypocalcemia. Moderate hyperkalemia is associated with arrhythmias and muscle weakness. Severe hypomagnesemia is associated with malnutrition. Moderate hyperphosphatemia damages the skeletal muscle tissues.

What food is appropriate for the patient with hypoparathyroidism to include in the diet? - Milk - Yogurt - Cheese - Soy milk

- Soy milk The patient with hypoparathyroidism must include foods that are rich in calcium and low in phosphorous. Therefore, the patient should include soy milk in the diet because it is low in phosphorous. Foods such as milk, yogurt, and cheese are to be avoided because of their high phosphorous content.

The primary health care provider prescribes IV phosphates to a patient with hyperparathyroidism. The patient reports tingling and numbness in the muscles after the treatment. What could be the reason behind this? - Sudden drop in serum calcium levels - Sudden drop in serum magnesium levels - Sudden drop in phosphorous levels - Sudden drop in serum PTH levels

- Sudden drop in serum calcium levels Patients with hyperparathyroidism are prescribed oral and IV phosphates. IV phosphates are used only when the serum calcium levels need to be lowered rapidly. This rapid decrease in the serum calcium levels causes tingling and numbness in the muscles. IV administration of phosphates does not alter the serum magnesium levels. Decreased serum phosphorous levels may not cause tingling and numbness in the muscles. IV phosphates does not decrease the serum PTH levels.

A patient is suspected of having hyperparathyroidism. The primary health care provider diagnoses the cause as hyperplasia. What treatment would be most effective for this condition? - Medication management - Fluid and electrolyte management - Surgical removal of nearly all parathyroid glands - Surgical removal of the affected parathyroid gland

- Surgical removal of nearly all parathyroid glands Surgical removal of nearly all parathyroid glands is the most effective treatment when hyperparathyroidism is due to hyperplasia. Diuretics are used in the medication management of primary hyperparathyroidism; this treatment may not be effective in hyperplasia conditions. Fluid and electrolyte therapy is used as a medical management of primary hyperparathyroidism but may not be effective in hyperplasia conditions. Surgical removal of the affected parathyroid glands is the best option in the case of diseased glands, such as tumors.

A patient has hyperparathyroidism. Which incident witnessed by the nurse requires the nurse's intervention? - Visitors talking with the patient about going home - The patient eating a morning meal of cereal and fruit - The physical therapist walking with the patient in the hallway - UAP pulling the patient up in bed by the shoulders

- UAP pulling the patient up in bed by the shoulders The patient with hyperparathyroidism is at risk for pathologic fracture. All members of the health care team must move the patient carefully. A lift sheet should be used to reposition the patient.

Which is a nonsurgical treatment for hypoparathyroidism? - Vitamin therapy - Diuretic therapy - Hydration therapy - Calcimimetic therapy

- Vitamin therapy Vitamin therapy to correct vitamin D deficiency is a nonsurgical treatment used for patients with hypoparathyroidism. Diuretic, hydration, and calcimimetic therapy are nonsurgical interventions for patients with hyperparathyroidism.

A patient underwent a parathyroid function test, and the results were serum calcium of 12 mg/dL and serum magnesium of 3 mEq/L. What levels of serum phosphorous should the nurse expect? - 2 mg/dL - 3 mg/dL - 4 mg/dL - 5 mg/dL

- 2 mg/dL The serum levels of calcium, magnesium, and phosphorous of a normal adult are 9-10 mg/dL, 1.3-2.1 mEq/dL, and 3-4.5 mg/dL respectively. In hyperparathyroidism, the serum levels of calcium and magnesium are increased, and the serum phosphorous level is decreased. The calcium and magnesium levels in the given scenario indicate hyperparathyroidism. Therefore, the nurse expects the serum phosphorous level to be below normal, or 2 mg/dL. 5 mg/dL is slightly elevated.

What class of drugs is most appropriate for treating hyperparathyroidism? - Diuretics - Hormones - Calcimimetics - Glucocorticoids

- Calcimimetics Drug therapy for patients with hyperparathyroidism involves the use of cinacalcet. This drug belongs to the class of calcimimetics. Diuretics are used to reduce serum calcium levels in patients who have milder disease. Hormone replacement therapy is used to treat the symptoms of endocrinal disorders. Therapeutic effects are greatly enhanced if calcitonin is given along with glucocorticoids.

If a patient has hyperparathyroidism and receives hydration therapy, how often does the nurse monitor the patient? - Every 2 hours - Every 12 hours - Every 16 hours - Every 30 minutes

- Every 2 hours When a patient with hyperparathyroidism receives hydration therapy, the nurse monitors and checks on the patient every two hours.

While assessing a patient with hypoparathyroidism, the patient reports tingling and numbness of the hands and feet. Which condition does the nurse suspect? - Severe hypokalemia - Moderate hypocalcemia - Severe hypophosphatemia - Moderate hypermagnesemia

- Moderate hypocalcemia Moderate hypocalcemia presents with tingling and numbness of the hands and feet. Severe hypokalemia causes flaccid paralysis. Sever hypophosphatemia causes muscle dysfunction and weakness. Moderate hypermagnesemia causes weakness.

What is hyperplasia? - Cellular decay - Tissue overgrowth - Excessive hydration - Tingling and numbness

- Tissue overgrowth Hyperplasia is tissue overgrowth and is one of the causes of hyperparathyroidism. The other options are incorrect.

The registered nurse is teaching a student nurse about the care plan for a patient with hypoparathyroidism. Which statement made by the student nurse indicates a need for further teaching? - "I will counsel the patient to help decrease the anxiety." - "I will advise the patient to wear a medical alert bracelet." - "I will explain to the patient that hypocalcemia therapy is short-term." - "I will teach the patient about the necessary dietary changes to increase calcium intake and decrease phosphorous intake."

- "I will explain to the patient that hypocalcemia therapy is short-term." Hypocalcemia therapy in a patient with hypoparathyroidism is long-term, not short-term.

What kinds of GI problems are common when serum calcium levels are high? SATA - Obesity - Diarrhea - Anorexia - Vomiting - Constipation

- Anorexia - Vomiting - Constipation When serum calcium levels are high, a patient may experience anorexia, vomiting, and constipation. Obesity and diarrhea are not associated with high serum calcium levels.

What integumentary change does the nurse expect while assessing the skin of a patient with hyperparathyroidism? - Waxy pallor - Diaphoresis - Soft body hair - Cool, dry skin

- Waxy pallor The patient with long-standing hyperparathyroidism may have a waxy pallor. Hyperthyroidism causes diaphoresis or excessive sweating because of heat intolerance. The patient also has soft body hair with hyperthyroidism. Cool, dry skin is found in the patient with hypothyroidism as a result of intolerance to cold.

What is the most common cause of hyperparathyroidism? - Chronic kidney disease - Cancer of the parathyroid glands - Neck or head radiation exposure - Benign tumor in a parathyroid gland

- Benign tumor in a parathyroid gland The most common cause of hyperparathyroidism is a benign tumor in one of the parathyroid glands. CKD, cancer of the parathyroid glands, and neck or head radiation exposure can cause hyperparathyroidism but are less common causes.