21-parathyroid Gland Flashcards
If parathyroid has very little fat, what does it mean
It is active
What cells are in parathyroid and what do they make
Chief cells -PTH
Oxyphil cells
What controls the PTH
Free levels of ionized calcium in blood stream
How do osteoblasts active osteoclasts
IL-1
What is calcium bound to
Albumin
Phosphate
Citrate
What gives the negative feedback for PTH
Free ionized calcium
What is hypoalbuminemia
Decrease total serum calcium but Norma ionized calcium
So normal PTH
When is tetany seen
Only when free ionized levels of calcium are low
What does an alkalosis state do to your calcium levels
PTH is high
Bound calcium is increased
Free calcium decreased
What are the causes for primary hyperparathyroidsism
Parathyroid adenoma -mc
Parathyroid hyperplasia 2mc
Parathyroid cancer
How does primary Hyperparathyrodism occurs
Sporadic or men1 or men 2a
How to primary parathyroid labs look like
Increased PTH
Increased Ca
Decreased phosphorus
Parathyroid adenoma anatomy
Solitary tumor and other three atrophy
Parathyroid hyperplasia anatomy
Whole thyroid involved
Parathyroid carcinoma anatomy
Same as adenoma with involvement of one gland and nodular
Only sign is metastasis
Mcc of Hypercalcemia in population
Unregulated over production of ptH by gland
What is the gland mostly involved in parathyroid adenoma
Right lower parathyroid gland
How does the tc99 parathyroid scan show in parathyroid adenoma
There is uptake
What glands are involved in parathyroid hyperplasia
All four so very little fat present
Symptoms of primary hyperparathyroidism
Bone pain
Renal stones
Abdominal groans
Physics moans
Metastatic calcification a to several areas
What does primary hyperparathyroidism lead to in the bone
Brown tumors - bulbous swellings
What are brown tumors made of
Osteoclasts and fibroblast form tumor like lesions resembling giant cell tumors of bone - have hermosoderin
What does primary hyperparathyroidism do to the kidney
Calcium oxalate renal stones - nephrolothiasis -mc
Nephrocalcinosis - calcification of renal tubules -no ADH -nephrogenic DI
What is Nephrocalcinosis - and what does it lead to
In 1 para-hyper calcification of renal tubules -no ADH -nephrogenic DI
Most common complain in 1 hyperparathyroidism and why
Constipation because gastrin decreases GI motility
Mc presentation in 1hyperparathyrodism
Nephrolothiasis
Osteitis fibrosa cystica ?
1hyper parathyroidism cystic and hemorrhagic bone lesions
Found in jaw and fingers
Eventually rupture blood vessels - leads to brown tumor
1hyper PTH bone X-ray
Subperosteal bone resorption
Salt and pepper appearance
Cns effects of primary hyper parathyroidism
Depression and seizures
Cvs effects of primary hyper parathyroidism
Short qt interval
Diastolic hypertension
Eye effects of primary hyper parathyroidism
Band keratopathy in the limbus of eyes due to metastatic calcification a
What does Ca high low PTH mean
And what causes it
Secondary Hypercalcemia
Malignancy -scc, rcc
Sarcoidosis-vit d hyper
Thiazides
Hupervotaminosis
What does multiple myeloma secrete from plasma cells to cause secondary Hypercalcemia
Il-1
Sarcoidosis cause secondary Hypercalcemia by
macrophages in Granuloma secreting 1-alpha hydroxylase leading to hypervotaminosis D
-absorb too much calcium so PTH down
What does vitamin d do
Increase Jejunum calcium absorption
Lab for secondary hyperparathyroidism
Decreased calcium ,increased PTH increased phosphate
Mcc of 2 hyperparathyroidism
Chronic renal failure
Sequence of 2 hyperparathyroidism
CRD causes increased phosphate which increased PTH which decrease calcium
Renal osteodystrophy is what and where is it found
Seconds hyperparathyroidism where excess PTH causes bone lesions
Tertiary par hyperthyrodism is after what
Renal transplant or efficient renal dialysis where stimulated parathyroid glands remain active
