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Endocrine > 403 Parathyroid > Flashcards

403 Parathyroid Flashcards

1
Q

Located posterior to thyroid gland

A

Four parathyroid glands

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2
Q

Primary regulator of calcium physiology

A

Parathyroid hormone

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3
Q

Where is calcium reabsorped

A

Distal tubule of kidneys

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4
Q

Hormone that increases gastrointestinal calcium absorption

A

1,25 OH2 D

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5
Q

Can suppress PTH secretion

A

Fibroblasts growth factor 3 (FGF3)

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6
Q

Characterized by excess production of PTH by an autonomously functioning adenomas or hyperplasia

A

Hyperparathyroidism

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7
Q

Cause of humoral hypercalcemia of malignancy

A

Overproduction of parathyroid hormone related peptide (PTHrP) secreted by cancer cells

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8
Q

Primary function of PTH

A

Maintain extracellular fluid calcium concentration

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9
Q

amount of calcium transferred between the ECF and bone each day

A

12 mmol or 500 mg of calcium

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10
Q

crucial to the bone forming effect of PTH

A

Osteoblasts which have PTH/ PTHrP receptors

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11
Q

strongly suppresses PTH gene transciption

A

1,25(OH)2D

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12
Q

True or false. in patients with renal faillure, IV administration of supraphysiologic concentrations of 1,25(OH)2D or analogues dramatically suppresses PTH overproduction

A

True.

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13
Q

normal range of PTH

A

1.9-2.0 nmol/L or 7.6- 8.0 mg/dL

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14
Q

where does much of the proteolysis of the PTH hormone happen

A

liver and kidney

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15
Q

syndrome that resembles primary HPT but without elevated PTH levels

A

humoral hypercalcemia of malignancy

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16
Q

acts as an indirect antagonist to the calcemic actions of PTH

A

calcitonin

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17
Q

what is the hypocalcemic activity of calcitonin

A

inhibition of osteoclast mediated bone resorption and secondarily by stimulation of renal calcium clearance

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18
Q

major source of calcitonin

A

thyroid

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19
Q

True or false. Cells involved in calcitonin synthesis arise from neural crest tissue

A

True.

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20
Q

Therapeuticalyl 10-100 times more potent than mammalian forms in lower serum calcium

A

calcitonin from salmon

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21
Q

account for 90% of all causes of hypercalcemia

A

parathyroid related, malignancy related, vitamin D related, associated with high bone turnover, associated with renal failure

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22
Q

manifestation of hypercalcemia on ECG

A

short QT interval

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23
Q

second most common cause of hypercalcemia in adult

A

malignancy

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24
Q

interval between detection of hypercalcemia and death esp without vigorous treatement

A

interval between detection of hypercalcemia and death esp without vigorous treatment

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25
Q

True or false. Differentiating primary hyperparathyroidism from occult malignancy can be occasionally difficult.

A

True.

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26
Q

True or false. Severe hypercalcemia is a medical emergency as it can lead to coma and cardiac arrest

A

True.

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27
Q

Classification of causes of hypercalcemia (5)

A

parathyroid related, malignancy related, vitamin D related, associated with high bone turnover, associated with renal failure

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28
Q

What level of serum calcium when symptoms appear

A

What level of serum calcium when symptoms appear

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29
Q

What is the serum calcium level for severe hypercalcemia

A

serum calcium more than 3.7- 4.5 mmol or 14.8- 18.0 mg/ dL

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30
Q

True or false. Parathyroid carcinoma are often aggressive.

A

False.

31
Q

True or false. Manifestations of hyperparathyroidism involve primary the kidneys and skeletal system

A

True.

32
Q

distinct bone manifestation of hyperparathyroidism

A

distinct bone manifestation of hyperparathyroidism

33
Q

Pathognomonic features of osteitis fibrosa cystica

A

Pathognomonic features of osteitis fibrosa cystica

34
Q

defined as biochemically confirmed hyperparathyroidism elevated or inappropriately normal PTH levels despite hypercalcemia with the absence of signs and symptoms typically associated with more severe hyperparathyroidism such as features of renal or bone disease

A

asymptomatic primary hyperparathyroidism

35
Q

guidelines for surgery in asymptomatic primary hyperparathyroidism

A

serum calcium more than 1 mg/dl; CrCl less than 60 ml/min; bone density T score less than -2.5 at any of 3 sites; age less than 50 yrs old

36
Q

guidelines for monitoring asymptomatic primary hyperparathyroidism

A

annually: serum calcium, serum creatinine, bone density; recommended: 24h urine calcium, creatinine clearance

37
Q

definitive therapy for hyperparathyroidism

A

surgical excision of the abnormal parathyroid tissue

38
Q

True or false. Serum calcium falls 24h after successful surgery and remain low normal for 3-5 days until remainin parathyroid tissue resumes full hormone secretion

A

True.

39
Q

coexistent electrolyte imbalance must be considered because it can interferes with PTH secretion and causes functional hypoparathyroidism

A

hypomagnesemia

40
Q

level of serum calcium associated with Chvostek and Trousseau’s signs

A

serum calcium less than 2 mmol/L or less than 8 mg/dl

41
Q

calcium infusion sufficient to correct hypocalcemia

A

0.5- 2 mg/kg per hour or 30-100 ml/ h of a 1 mg/ml solution

42
Q

what should be added to calcium infusion is correction takes more than 2-3 days

A

vitamin D analoque and or oral calcium added

43
Q

cost effective vitamin D analogue

A

Calcitriol 0.5-1 ug/ day for rapid onset action and prompt cessation when stopped

44
Q

how if hypomagnesemia managed?

A

parenteral replacement 0.5-1.0 mmol/kg of body weight can be administered; total doses of 20-40 mmol are sufficient

45
Q

used in the management of bipolar depression and other psychiatric disorders which causes hypercalcemia in 10% of treated patients

A

lithium

46
Q

inherited as an autosomal dominant trait wherein affected individuals present with asymptomatic hypercalcemia

A

Familial benign hypercalcemia

47
Q

rare autosomal domainant disorder caused by activating mutations in the PTH/PTHrP that lead to short limed dwarfism

A

Jansen disease

48
Q

Treatment of hypercalcemia of malignancy

A

directed at control of tumor

49
Q

among of vitamin D required to produce significant hypercalcemia

A

chronic ingestion 40-100 times the normal (amounts > 40,000- 100,000 U/d)

50
Q

upper limit of dietary intake of vitamin D

A

2000 U/day

51
Q

rare autosomal dominant disorder characterized by multiple congenital development defects including supravalvular aortic stenosis, mental retardation, and elfin facies in association with hypercalcemia due to abnormal sensitivity to vitamin D

A

William’s syndrome or idiopathic hypercalcemia of infancy

52
Q

which is more common in hyperthyroidism: hypercalcemia or hypercalciuria

A

hypercalciuria

53
Q

rare cause of hypercalcemia caused by dieatary faddism

A

vitamin A intoxication

54
Q

at what dosage of vitamin can lead to hypercalcemia

A

50,000-100,000 units of vitamin A daily (that’s 10-20 times the minimum daily requirement)

55
Q

important stimulus in the development of secondary hyperparathyroidism in renal disease

A

FGF23 dependent reduction in 1,25(OH)2 vitamin D; potent inhibitor of renal 1- alpha hydroxylase

56
Q

evaluation of hypercalcemia. acute. PTH high

A

primary hyperparathyroidism consider MEN syndromes

57
Q

evaluation of hypercalcemia. acute. PTH low

A

consider malignancy, PTHrP assay, clinical evaluation

58
Q

evaluation of hypercalcemia. acute. PTH low. Negative malignancy

A

Granulomatous disease, FHH, milk alkali syndrome, medication, Vitamin A or D intoxication, adrenal insufficiencym hyperthyroidism

59
Q

evaluation of hypercalcemia. chronic. PTH high

A

hyperparathyroidism consider MEN syndromes

60
Q

evaluation of hypercalcemia. acute. PTH low

A

Granulomatous disease, FHH, milk alkali syndrome, medication, Vitamin A or D intoxication, adrenal insufficiencym hyperthyroidism

61
Q

Management. Mild hypecalcemia. Less than 3 mmol/L or 12 mg/dL

A

hydration

62
Q

Management, More sever hypercalcemia. 3.2 to 3.7 mmol or 13-15 mg/dL

A

decrease serum calcium 0.7-2.2 mmol/L (3-9 mg/dL) within 24-48 ours

63
Q

antibody that blockls RANK ligand and reduce osteoclast number and function and approved therapy for osteoporosis

A

denosumab

64
Q

how is pamidronate given in the treatment of hypercalcemia

A

30-90 mg pamidronate given as a single IV dose over a few hours

65
Q

how is zolendorante given in the treatment of hypercalcemia

A

4 or 8 mg/5 min infusion

66
Q

True or false. after 24 hr of use, calcitonin is no longer effective in lowering calcium

A

True.

67
Q

acts on the osteoclasts to block bone resorption

A

calcitonin

68
Q

usual dose of calcitonin

A

2-8 U/KBW IV, SC, or IM every 6-12 h

69
Q

increased urinary calcium excretion and decrease intenstinal calcium absorption

A

glucocorticoids

70
Q

treatment of choice for severe hypercalcemia which is difficult to manage medically

A

dialysis

71
Q

True or false. Chronic hypocalcemia is less common than hypercalcemia

A

True.

72
Q

Leads to transient hypocalcemia

A

severe sepsis, burns, AKI, extensive transfusions with citrated blood

73
Q

True or false. Although half of patients in ICU have calcium concentrations of less than 2.1 mmol (less than 8.5 mg/dl), most do not have reduction in ionized calcium

A

True.

74
Q

Medications that lead to transient hypocalcemia

A

protamine, heparin, glucagon

Endocrine (15 decks)

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