ICD-10: E20.811

Secondary hypoparathyroidism, classified under ICD-10 code E20.811, is a condition characterized by inadequate parathyroid hormone (PTH) secretion due to underlying diseases that affect the parathyroid glands or calcium metabolism. Understanding its clinical presentation, signs, symptoms, and patient characteristics is crucial for accurate diagnosis and management.

Clinical Presentation

Overview

Secondary hypoparathyroidism occurs when the parathyroid glands fail to produce sufficient PTH in response to low calcium levels, often due to chronic kidney disease (CKD) or other systemic diseases. This condition is typically a compensatory response to maintain calcium homeostasis in the body.

Common Causes

• Chronic Kidney Disease (CKD): The most prevalent cause, where impaired kidney function leads to decreased conversion of vitamin D to its active form, resulting in reduced intestinal absorption of calcium and subsequent hypocalcemia.
• Vitamin D Deficiency: Conditions leading to inadequate vitamin D levels can also contribute to secondary hypoparathyroidism.
• Malabsorption Syndromes: Disorders that impair nutrient absorption can lead to deficiencies in calcium and vitamin D, triggering secondary hypoparathyroidism.

Signs and Symptoms

Hypocalcemia Symptoms

Patients with secondary hypoparathyroidism often present with symptoms related to low calcium levels, which may include:
- Neuromuscular Symptoms: Muscle cramps, spasms, and tetany (involuntary muscle contractions).
- Paresthesia: Tingling sensations, particularly around the mouth and in the extremities.
- Seizures: In severe cases, hypocalcemia can lead to seizures due to increased neuronal excitability.
- Cardiac Symptoms: Prolonged QT interval on ECG, which can lead to arrhythmias.

Other Clinical Features

• Bone Pain and Deformities: Chronic hypocalcemia can lead to bone pain, osteomalacia, or rickets in children.
• Fatigue and Weakness: Generalized fatigue and muscle weakness are common complaints.
• Dry Skin and Hair: Patients may experience dermatological changes, including dry skin and brittle hair.

Patient Characteristics

Demographics

• Age: Secondary hypoparathyroidism is more common in older adults, particularly those with chronic kidney disease.
• Gender: There may be a slight female predominance, especially in cases related to autoimmune conditions or vitamin D deficiency.

Comorbid Conditions

• Chronic Kidney Disease: A significant proportion of patients with secondary hypoparathyroidism have underlying CKD, which complicates their management.
• Autoimmune Disorders: Conditions such as systemic lupus erythematosus (SLE) or Sjögren's syndrome can also be associated with secondary hypoparathyroidism due to their effects on calcium metabolism.

Lifestyle Factors

• Dietary Habits: Patients with poor dietary intake of calcium and vitamin D are at higher risk.
• Medication Use: Certain medications, such as anticonvulsants or glucocorticoids, can affect calcium metabolism and contribute to the development of secondary hypoparathyroidism.

Conclusion

Secondary hypoparathyroidism (ICD-10 code E20.811) is a complex condition often resulting from chronic diseases, particularly CKD. Its clinical presentation is marked by symptoms of hypocalcemia, including neuromuscular irritability and bone pain. Understanding the patient characteristics, including age, comorbidities, and lifestyle factors, is essential for effective diagnosis and management. Early recognition and treatment of the underlying causes are crucial to prevent complications associated with this condition.

ICD-10 code E20.811 refers to Secondary hypoparathyroidism in diseases classified elsewhere. This condition is characterized by low levels of parathyroid hormone (PTH) due to another underlying disease, often related to chronic kidney disease or vitamin D deficiency. Understanding alternative names and related terms can help in clinical documentation, billing, and coding processes.

Alternative Names for E20.811

1. Secondary Hyperparathyroidism: While this term typically refers to the overactivity of the parathyroid glands due to low calcium levels, it is important to differentiate it from secondary hypoparathyroidism, which involves insufficient PTH production.

2. Hypoparathyroidism due to Chronic Kidney Disease: This term is often used in clinical settings to specify the underlying cause of the hypoparathyroidism, particularly when kidney disease is the primary issue.

3. Vitamin D Deficiency-Induced Hypoparathyroidism: This name highlights the role of vitamin D deficiency in causing secondary hypoparathyroidism, as vitamin D is crucial for calcium metabolism and PTH regulation.

4. Hypoparathyroidism Secondary to Other Diseases: A broader term that encompasses various conditions leading to secondary hypoparathyroidism, emphasizing that it is a consequence of other health issues.

Related Terms

1. Parathyroid Hormone (PTH): The hormone whose deficiency characterizes hypoparathyroidism. Understanding its role is crucial for diagnosing and managing the condition.

2. Chronic Kidney Disease (CKD): A common underlying cause of secondary hypoparathyroidism, where the kidneys fail to maintain normal calcium and phosphate levels, leading to altered PTH secretion.

3. Hypocalcemia: A condition often associated with hypoparathyroidism, characterized by low calcium levels in the blood, which can result from insufficient PTH.

4. Vitamin D Deficiency: A significant factor in the development of secondary hypoparathyroidism, as vitamin D is essential for calcium absorption and PTH regulation.

5. Metabolic Bone Disease: This term encompasses various disorders affecting bone metabolism, including those related to hypoparathyroidism, particularly in the context of CKD.

6. Assays for Parathyroid Hormone: Refers to laboratory tests used to measure PTH levels, which are critical for diagnosing and managing hypoparathyroidism.

Conclusion

Understanding the alternative names and related terms for ICD-10 code E20.811 is essential for healthcare professionals involved in diagnosis, treatment, and coding. This knowledge aids in accurate documentation and ensures that patients receive appropriate care based on their underlying conditions. If you need further information on coding practices or related conditions, feel free to ask!

Secondary hypoparathyroidism, classified under ICD-10 code E20.811, is a condition characterized by low levels of parathyroid hormone (PTH) due to other underlying diseases, most commonly chronic kidney disease (CKD). This condition can lead to disturbances in calcium and phosphate metabolism, necessitating a comprehensive treatment approach. Below, we explore standard treatment strategies for managing secondary hypoparathyroidism.

Understanding Secondary Hypoparathyroidism

Secondary hypoparathyroidism occurs when the parathyroid glands are unable to produce adequate amounts of PTH in response to low serum calcium levels, often due to chronic conditions such as CKD, vitamin D deficiency, or malabsorption syndromes. The primary goal of treatment is to manage the underlying condition while correcting calcium and phosphate imbalances.

Treatment Approaches

1. Management of Underlying Conditions

• Chronic Kidney Disease (CKD): The primary focus is on managing CKD through dietary modifications, fluid management, and medications to control blood pressure and diabetes, if applicable. This can help slow the progression of kidney disease and its complications, including secondary hypoparathyroidism[1].

2. Calcium and Vitamin D Supplementation

• Calcium Supplements: Patients may require calcium carbonate or calcium citrate supplements to maintain serum calcium levels. The dosage should be tailored to the individual’s needs and monitored regularly to avoid hypercalcemia[2].

• Vitamin D Analogues: Active forms of vitamin D, such as calcitriol (1,25-dihydroxyvitamin D), are often prescribed to enhance intestinal absorption of calcium and to suppress PTH secretion. Other vitamin D analogues, like paricalcitol or doxercalciferol, may also be used, especially in patients with CKD[3].

3. Phosphate Binders

• Phosphate Control: In patients with CKD, managing phosphate levels is crucial. Phosphate binders, such as sevelamer, lanthanum carbonate, or calcium acetate, can help reduce serum phosphate levels, which in turn can alleviate the stimulus for PTH secretion[4].

4. Monitoring and Adjustments

• Regular Monitoring: Patients should undergo regular monitoring of serum calcium, phosphate, and PTH levels to assess the effectiveness of treatment and make necessary adjustments. This is particularly important in patients with fluctuating kidney function or those undergoing dialysis[5].

5. Dialysis Considerations

• Dialysis Patients: For patients on dialysis, specific protocols may be implemented to manage mineral and bone disorders. This includes adjusting dialysis prescriptions to optimize phosphate removal and ensuring adequate vitamin D levels[6].

6. Surgical Options

• Parathyroidectomy: In rare cases where medical management fails, surgical intervention may be considered. This typically involves parathyroidectomy, which is the removal of one or more parathyroid glands, although this is more common in primary hyperparathyroidism than in secondary cases[7].

Conclusion

The management of secondary hypoparathyroidism (ICD-10 code E20.811) requires a multifaceted approach that addresses both the underlying causes and the biochemical imbalances associated with the condition. Regular monitoring and adjustments to treatment regimens are essential to ensure optimal patient outcomes. Collaboration among healthcare providers, including nephrologists, endocrinologists, and dietitians, is crucial for effective management of this complex condition.

References

1. Chronic Kidney Disease Management Guidelines.
2. Calcium Supplementation in CKD Patients.
3. Role of Vitamin D in Secondary Hyperparathyroidism.
4. Phosphate Binders in CKD Management.
5. Monitoring Guidelines for Mineral and Bone Disorders.
6. Dialysis Protocols for Mineral Management.
7. Surgical Options for Hyperparathyroidism.

The ICD-10 code E20.811 refers to secondary hypoparathyroidism that occurs as a result of diseases classified elsewhere. This condition is characterized by insufficient parathyroid hormone (PTH) production due to underlying health issues, which can lead to disturbances in calcium and phosphate metabolism.

Diagnostic Criteria for E20.811

1. Clinical Presentation

• Symptoms: Patients may present with symptoms related to low calcium levels (hypocalcemia), which can include muscle cramps, tingling in the fingers and toes, fatigue, and in severe cases, seizures or cardiac issues.
• History: A thorough medical history is essential to identify any underlying conditions that may contribute to secondary hypoparathyroidism, such as chronic kidney disease, vitamin D deficiency, or other endocrine disorders.

2. Laboratory Tests

• Serum Calcium Levels: Low serum calcium levels are a hallmark of hypoparathyroidism. Normal calcium levels typically range from 8.5 to 10.2 mg/dL.
• Parathyroid Hormone Levels: In secondary hypoparathyroidism, PTH levels may be low or inappropriately normal despite low calcium levels, indicating that the parathyroid glands are not responding adequately to the calcium status.
• Phosphate Levels: Elevated serum phosphate levels may also be observed, particularly in cases related to chronic kidney disease.

3. Underlying Conditions

• Chronic Kidney Disease (CKD): This is one of the most common causes of secondary hypoparathyroidism. In CKD, the kidneys are unable to excrete phosphate effectively, leading to hyperphosphatemia and subsequent suppression of PTH secretion.
• Vitamin D Deficiency: Insufficient vitamin D can impair calcium absorption from the gut, leading to low serum calcium and secondary hypoparathyroidism.
• Other Endocrine Disorders: Conditions such as hypercalcemia due to malignancy or other metabolic disorders can also lead to secondary hypoparathyroidism.

4. Imaging Studies

• While not always necessary, imaging studies may be used to assess the parathyroid glands or to evaluate for any underlying conditions that could be contributing to the hypoparathyroidism.

5. Exclusion of Primary Causes

• It is crucial to rule out primary hypoparathyroidism (E20.9) and other causes of hypocalcemia before diagnosing secondary hypoparathyroidism. This may involve genetic testing or further endocrine evaluations.

Conclusion

The diagnosis of secondary hypoparathyroidism (ICD-10 code E20.811) involves a combination of clinical evaluation, laboratory testing, and consideration of underlying health conditions. Proper identification of the cause is essential for effective management and treatment of the condition. If you suspect secondary hypoparathyroidism, it is advisable to consult with a healthcare professional for a comprehensive assessment and appropriate diagnostic testing.

Clinical Description of ICD-10 Code E20.811: Secondary Hypoparathyroidism

ICD-10 Code E20.811 refers specifically to secondary hypoparathyroidism, a condition characterized by insufficient parathyroid hormone (PTH) production due to underlying diseases that affect the parathyroid glands or their function. This condition is classified under the broader category of hypoparathyroidism, which encompasses various etiologies, including primary and secondary forms.

Definition and Pathophysiology

Secondary hypoparathyroidism occurs when the parathyroid glands are stimulated to produce less PTH in response to low calcium levels, often due to chronic kidney disease (CKD) or other systemic diseases. In CKD, the kidneys fail to adequately convert vitamin D to its active form, leading to decreased intestinal absorption of calcium and subsequent hypocalcemia. This triggers compensatory mechanisms that can ultimately lead to parathyroid gland dysfunction and reduced PTH secretion[1][2].

Causes

The primary causes of secondary hypoparathyroidism include:

• Chronic Kidney Disease (CKD): The most common cause, where impaired renal function leads to disturbances in calcium and phosphate metabolism.
• Vitamin D Deficiency: Conditions that result in inadequate vitamin D levels can lead to decreased calcium absorption, prompting the parathyroid glands to reduce PTH production.
• Malabsorption Syndromes: Disorders that impair nutrient absorption can also contribute to low calcium levels and secondary hypoparathyroidism.
• Other Endocrine Disorders: Conditions affecting the endocrine system may also lead to secondary hypoparathyroidism through various mechanisms.

Clinical Presentation

Patients with secondary hypoparathyroidism may present with symptoms related to low calcium levels, including:

• Muscle cramps or spasms
• Numbness and tingling, particularly around the mouth and in the extremities
• Fatigue and weakness
• Seizures in severe cases

Additionally, patients may exhibit signs of underlying conditions, such as those associated with CKD, including hypertension and edema[3].

Diagnosis

Diagnosis of secondary hypoparathyroidism typically involves:

• Laboratory Tests: Measurement of serum calcium, phosphate, and PTH levels. In secondary hypoparathyroidism, PTH levels are often low or inappropriately normal despite low serum calcium.
• Imaging Studies: In some cases, imaging may be necessary to assess for underlying conditions affecting the parathyroid glands or kidneys.

Treatment

Management of secondary hypoparathyroidism focuses on treating the underlying cause and may include:

• Calcium and Vitamin D Supplementation: To correct deficiencies and improve calcium levels.
• Phosphate Binders: In patients with CKD, these can help manage elevated phosphate levels, which can exacerbate hypoparathyroidism.
• Monitoring and Management of CKD: Addressing kidney function through dietary modifications, medications, or dialysis as necessary.

Conclusion

ICD-10 code E20.811 for secondary hypoparathyroidism highlights the importance of recognizing and managing this condition in the context of underlying diseases. Effective treatment hinges on addressing the root causes, particularly in patients with chronic kidney disease or vitamin D deficiency. Regular monitoring and a multidisciplinary approach are essential for optimal patient outcomes[4][5].

References

1. ICD-10 code E20.811 for Secondary hypoparathyroidism in diseases classified elsewhere.
2. Billing and Coding: Vitamin D Assay Testing (A57718).
3. Hypoparathyroidism E20 - ICD-10-CM Codes.
4. ICD-10-CM Diagnosis Code E20: Hypoparathyroidism.
5. E20.81 - Hypoparathyroidism due to impaired parathyroid hormone.