ABSITE Review - Parathyroid Flashcards

1
Q

What pouch does the superior and inferior parathyroid originate from?

A

Superior parathyroids - 4th pouch

Inferior parathyroids - 3rd pouch

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2
Q

What is the relation of the superior and inferior parathyroid glands to the RLN?

A

Superior parathyroids - Lateral to RLN, above inferior thyroid artery
Inferior parathyroids - Medial to RLN, more anterior, below inferior thyroid artery

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3
Q

What is the MC ectopic site for the inferior parathyroid glands?

A

Tail of the thymus

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4
Q

What is the MCC of hypoparathyroidism?

A

Previous thyroid surgery

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5
Q

What is the oncogen that increases the risk of parathyroid adenomas?

A

PRAD-1

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6
Q

How is hyperparathyroidism diagnosed?

A

High Ca, Low Phos, Cl:Phos ratio >33, high renal, high renal cAMP, HCO3- secreted in urine

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7
Q

What metabolic disturbance is seen in primary hyperparathyroidism?

A

Hyperchloremic metabolic acidosis

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8
Q

What is the name of the bone lesions from Ca resorption?

A

Osteitis fibrosa cystica (brown tumors)

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9
Q

What are the indications for surgery in Primary Hyperparathyroidism?

A

Symptomatic disease or asymptomatic disease with Ca >13, low Cr clearance, kidney stones, substantially low bone mass

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10
Q

What is the MCC of Primary Hyperparathyroidism?

A

Single adenoma in 80% patients

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11
Q

How the intraop PTH works?

A

Can help determine if the causative gland is removed (PTH should go to <50% of the preop value); PTH half life is 10 minutes

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12
Q

If you cannot find a parathyroid gland, what is the next step?

A

Check inferiorly in thymus tissue ( MC ectopic location), near carotids, vertebral body, superior to pharynx, thyroid

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13
Q

If you can still find the gland, what is the next step?

A

Intraop ultrasound

Close and follow PTH, if PTH still high, get parathyroid scan to localize

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14
Q

What is the cause of postop hypocalcemia?

A

Caused by bone hunger, hypoMg, failure of parathyroid remnant or graft

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15
Q

What is the utility of the sestamibi-technetium scan-99?

A

Good for picking up adenomas but not 4-gland hyperplasia

Best for trying to pick up ectopic glands

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16
Q

In which patients, is secondary hyperparathyroidism usually seen?

A

Renal failure patients

17
Q

What are the laboratory findings of 2ary Hyperparathyroidism?

A

Increase PTH in response to low Ca

18
Q

What is the treatment of 2ary Hyperparathyroidism?

A

Control diet phosphurus, PO4-binding gel, decrease aluminum, Ca supplement, vitamin D, Ca in dialysate

19
Q

What is the MC indication for surgery in 2ary hyperparathyroidism?

A

Bone pain

Others - fractures, or pruritus

20
Q

What is tertiary hyperparathyroidism?

A

Renal disease corrected with transplant but still overproduces PTH

21
Q

What is the surgery of choice for 2ary and 3ary hyperparathyroidism?

A

Subtotal (3.5 glands) or total parathyroidectomy with autotransplantation

22
Q

What lab findings are seen in familial hypercalcemic hypocalciuria

A

Increase serum calcium and low urine calcium

23
Q

What is the cause of familial hypercalcemic hypocalciuria?

A

Caused by defect in PTH receptor in distal convoluted tubule of the kidney that causes increase resorption of calcium

24
Q

In parathyroid cancer, what is the preferred surgery?

A

Wide en bloc excision (parathyroidectomy and ipsilateral thyroidectomy)

25
What is the inheritance of MEN syndrome?
Autosomal dominant
26
What are the classic findings of MEN I?
Parathyroid hyperplasia - usually 1st symptoms Pancreatic islet cell tumors - Gastrinoma #1, 50% multiple, 50% malignant Pituitary adenoma - Prolactinoma #1
27
What are the classic findings of MEN IIa?
Parathyroid hyperplasia Pheochromocytoma - often bilateral, almost always benign Medullary thyroid carcinoma - often bilateral, #1 cause of death CORRECT pheochromocytoma first
28
What are the classic findings of MEN IIb?
Pheochromocytoma - often bilateral, almost always benign Medullary thyroid carcinoma - often bilateral, #1 cause of death Mucosal Neuromas Marfan's habitus, MSK abnormalities CORRECT pheochromocytoma first
29
What is the gene and chromosome of MEN I?
MENIN gene in Ch 11
30
What is the gene and chromosome of MEN II?
RET proto-oncogene in Ch 10