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Endocrine > 2: Hyperparathyroidism > Flashcards

2: Hyperparathyroidism Flashcards

1
Q

What is hyperparathyroidism

A

High parathyroid hormone

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2
Q

What is primary hyperparathyroidism

A

Excess secretion PTH from parathyroid gland

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3
Q

What is secondary hyperparathyroidism

A

Hypocalcaemia leads to excess PTH secretion

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4
Q

What is tertiary hyperparathyroidism

A

Hypocalcaemia results in autonomous secretion of PTH from pituitary gland

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5
Q

What causes 80% of primary hyperparathyroidism

A

Pituitary adenoma

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6
Q

What are two other causes of primary hyperparathyroidism

A
  • Hyperplasia (20%)

- Carcinoma (0.5%)

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7
Q

What is the main cause of secondary hyperparathyroidism

A
  • CKD
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8
Q

What does CKD cause

A

Renal Osteodystrophy

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9
Q

What is another cause of secondary hyperparathyroidism

A

Vitamin D Deficiency

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10
Q

What causes tertiary hyperparathyroidism

A

Chronic Renal Failure

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11
Q

What is malignant hyperparathyroidism

A

Release of PTHrp by cancers

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12
Q

What 3 cancers release PTHrp

A
  • Renal Cell Carcinoma
  • Breast Cancer
  • Squamous Cell Carcinoma
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13
Q

What endocrine disorder can parathyroid also be related to

A

Multiple Endocrine Neoplasia (MEN)

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14
Q

What is multiple endocrine neoplasia

A

Collection of hormone secreting tumours

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15
Q

What is the inheritance of MEN

A

Autosomal Dominant

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16
Q

What gene is mutated in MEN 1

A

MEN1 gene

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17
Q

How does MEN 1 usually present

A

Hypercalcaemia

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18
Q

What are the 3 P’s of MEN 1

A
  1. Parathyroid
  2. Pancreas (Insulinoma, Gastrinoma)
  3. Pituitary
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19
Q

What tumours are other tumours are present in MEN1

A

Adrenal

Thyroid

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20
Q

What gene is mutated in Men IIa

A

RET Oncogene

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21
Q

What cancer is men IIa most commonly associated with

A

Medullary Thyroid Cancer (90%)

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22
Q

What is medullary thyroid cancer

A

Cancer of C-cells

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23
Q

What are 2P’s of Men IIa

A

Pheochromocytoma

Parathyroid

24
Q

What gene is mutated in men IIb

A

RET oncogene

25
Q

What P is present in men IIb

A

Phaeochromocytoma

26
Q

What other cancers occur in men IIb

A
  • Neurofibromatosis
27
Q

What is men IIb specially associated with

A
  • Marfinoid body habits

- NF

28
Q

What does neurofibromatosis cause

A

Bilateral vesicular schwanomas

29
Q

How is hyperparathyroidism usually found

A

Incidentally, symptoms are often retrospective

30
Q

What is the menumonic for symptoms of hypercalcaemia

A

stones, bones, groans and psychiatric overtones

31
Q

Explain ‘stones’

A

Renal stones

32
Q

Explain ‘bones’

A
  • Pain
  • Weakness
  • Fractures
  • Osteoporosis
33
Q

Explain ‘groans’

A
  • Tiredness
  • Duodenal ulcer
  • Pancreatitis
  • Polyuria, Polydipsia
34
Q

Explain ‘psychiatric overtones’

A
  • Depression
35
Q

What are symptoms of hyperparathyroidism due to BP

A
  • HTN
36
Q

what is the role of PTH

A
  • Stimulates osteoclasts and hence bone reabsorption and serum calcium
  • Inhibits phosphate reabsorption
  • Increases vitamin D
37
Q

explain renal osteodystrophy

A
  • CKD reduces hydroxylation and activation of vitamin D
  • This reduces calcium reabsorption in the gut and renal tubules - causing hypocalcaemia
  • Hypocalcaemia causes hyperparathyroidism
  • This leads to bone reabsorption
38
Q

what is first-line investigation for hyperparathyroidism

A

Bone profile

39
Q

what is adjusted calcium accounting for

A

Albumin.

As low albumin will cause hypocalcaemia on assay (despite normal calcium)

40
Q

how will phosphate present in hyperparathyroidism

A

Low

41
Q

when will PTH be high

A

1’ and 2’ hyperparathyroidism

42
Q

explain PTH in malignant hyperparathyroidism

A

PTH will be low.

PTHrp released from cancers is not detected on the assay. However, will cause hypercalcaemia which activates negative feedback inhibiting PTH release

43
Q

if pTH is normal what should you consider

A

lithium
thiazide diuretics
familial hypocalciuric hypocalcaemia

44
Q

what is second line for hyperparathyroidism

A

X-ray

DEXA scan

45
Q

what scan is used to detect pituitary adenoma

A

Technitium and Sestimibi scanning

46
Q

what is osteitis fibrosa cystica

A

occurs due to severe periosteal reabsorption. Presents with:

  • Brown tumours
  • Erosions
  • Cysts
  • Pepper pot skull
47
Q

how is mild hyperparathyroidism managed

A

Increase fluid intake (prevent stones)

Reduce calcium intake

48
Q

what is first-line for moderate hyperparathyroidism

A

Parathyroidectomy

49
Q

what are 4 indications of parathyroidectomy

A
  • Osteoporosis
  • Renal Stones
  • High Serum Calcium
  • Decrease renal function
50
Q

what is an alternative to parathyroidectomy

A

calcimimmetics (cinacalcet)

51
Q

what is role of cinacalcet

A

Increase sensitivity of chief cells to calcium and therefore reduces parathyroid secretion

52
Q

what artery innervates parathyroid glands

A

Inferior thyroid artery

53
Q

where do superior parathyroid glands arise

A

3rd pharyngeal pouch

54
Q

where do inferior parathyroid glands arise

A

4th pharyngeal pouch

55
Q

what can thyroid surgery lead to

A

hypocalcaemia

56
Q

what is required to monitor following parathyroidectomy

A

Calcium
Phosphate
Magnesium

57
Q

what is given following parathyroidectomy

A

Calcium

Vitamin D replacement

Endocrine (20 decks)

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