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.0.0 RSP Endocrine > [15] Hyperparathyroidism > Flashcards

[15] Hyperparathyroidism Flashcards

1
Q

What is PTH secreted in response to?

A

Decreased calcium

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2
Q

What is the effect of PTH?

A

Increased osteoclast activity
Increased calcium and decreased phosphate reabsorption in the kidney
Increased 1alpha-hydroxylation of 25OH-Vit D3

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3
Q

What is the presentation of hyperparathyroidism due to?

A

Increased calcium

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4
Q

What are the categories of symptoms of hyperparathyroidism?

A 
Renal
Bone
Psychological 
Abdominal
Other
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5
Q

What are the renal symptoms of hyperparathyroidism?

A

Renal stones
Polyuria and polydipsia
Nephrocalcinosis

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6
Q

What causes polyuria and polydipsia in hyperparathyroidism?

A

Nephrogenic diabetes insipidus

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7
Q

What are the bone symptoms of hyperparathyroidism?

A

Bone pain

Pathological fractures

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8
Q

What are the psychological symptoms of hyperparathyroidism?

A

Depression

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9
Q

What are the abdominal symptoms of hyperparathyroidism?

A 
Abdominal pain
Nausea and vomiting
Constipation
Pancreatitis
Peptic ulcer disease
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10
Q

What causes peptic ulcer disease in hyperparathyroidism?

A

Increased gastrin secretion

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11
Q

What are the other symptoms of hyperparathyroidism?

A

Increased BP

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12
Q

What are the causes of primary hyperparathyroidism?

A

Solitary adenoma
Hyperplasia
Parathyroid cancer

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13
Q

What % of cases of hyperparathyoidism are caused by a solitary adenoma?

A

80%

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14
Q

What % of cases of hyperparathyroidism are caused by hyperplasia?

A

20%

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15
Q

What % of cases of hyperparathyroidism are caused by parathyroid cancer?

A

<0.5%

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16
Q

What investigations are done in hyperparathyroidism?

A

Bloods
ECG
X-ray
DEXA

17
Q

What will be found on blood tests in hyperparathyroidism?

A

High calcium, with high or inappropriately normal PTH
Increased ALP
Decreased phosphate

18
Q

What may be found on ECG in hyperparathyroidism?

A

Decreased QTc, leading to bradycardia and 1st degree heart block

19
Q

What might be found on hand x-ray in hyperparathyroidism?

A

Osteitis fibrosa cystica, leading to phalangeal erosions

20
Q

What is the purpose of a DEXA scan in hyperparathyroidism?

A

Look for osteoporosis

21
Q

What are the general management measures in hyperparathyroidism?

A

Increase fluid intake
Avoid dietary calcium
Avoid thiazides

22
Q

What is the surgical management of hyperparathyroidism?

A

Excision

23
Q

What are the risks of excision in hyperparathyroidism?

A

Development of hypoparathyroidism

Recurrent laryngeal nerve palsy

24
Q

What are the causes of secondary hyperparathyroidism?

A

Vitamin D deficiency

Chronic renal failure

25
Q

What will be found on blood tests in secondary hyperparathyroidism?

A 
Increased PTH 
Decreased calcium
Increased phosphate
Increased ALP
Decreased vit D
26
Q

How is secondary hyperparathyroidism managed?

A

Correct cause
Phosphate binders
Vitamin D
Cinacalcet

27
Q

Give an example of a phosphate binder with calcium?

A

Calcichew

28
Q

Give two examples of phosphate binders without calcium

A

Sevelamer

Lanthanum

29
Q

What does cinacalcet do?

A

Increase parathyroid calcium sensitivity

30
Q

What causes tertiary hyperparathyroidism?

A

Prolonged secondary hyperparathyroidism leading to autonomous PTH secretion

31
Q

What will be found on blood tests in tertary hyperparathyroidism?

A

Increased calcium
Increased PTH
Decreased phosphate
Increased ALP

.0.0 RSP Endocrine (18 decks)

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