After Watching Parathyroid Lecture

Question 1

What can happen to the other parathyroid glands when one has an adenoma and why?

Answer 1

They can shrink because the adenoma is secreting so much PTH that there is negative feedback and the normal glands will respond while the adenoma will not.

Question 2

Good indication histologically that we are looking at normal PTH tissue?

Answer 2

FAT

Question 3

What syndrome should we be thinking with primary parathyroid hyperplasia and what is a big difference between this and adenoma of the parathyroid gland histologically?

Answer 3

Men1

No rim of normal PTH tissue around the hyperplasia

Question 4

Explain the mutations leading to parathyroid adenomas?

Answer 4

Germ line mutations of men 1 can lead to adenomas, but sporadic adenomas are more common from somatic mutations of men 1

Question 5

Number 1 indicator of parathyroid carcinoma and 2 other highly suggestive features of it?

Answer 5

Metastasis
Invasion of adjacent structures
Invasion of vasculature

Question 6

Talk about what surgery does to the parathyroid gland and how that is different with a parathyroid carcinoma?

Answer 6

When the surgeon removes the PT glands, they can measure PTH dropping in real time because it happens so quickly. In the case of a carcinoma, it does not drop after surgically removing the gland.

Question 7

So, if PTH does not drop after surgery, what am I thinking?

Answer 7

Carcinoma

Question 8

Why is primary para asymptomatic and malignancy symptomatic hypercalemia?

Answer 8

The process in primary para is very gradual, so the high calcium is an incidental finding. The malignancy is going to cause the symptoms.

Question 9

Explain what is going on in osteitis fibrosis cystica?

Answer 9

Essentially, destruction of the bone, so it is a reactive process of the bone. You have hemorrhaging, necrosis, reactive fibrosis.

Question 10

What does osteitis fibrosis cystica look like on bone scan?

Answer 10

Metastatic disease

Question 11

Explain the big difference between secondary and tertiary hyperparathyroidism?

Answer 11

In secondary, there is chronic low calcium so there is adaptive hyper plastic growth of all the glands to put out more PTH.
Tertiary is different in the sense that when you eventually fix the low calcium problem, the glands are so used to putting out tons of PTH that they continue to do it even though the low calcium problem has been fixed.

Question 12

What is renal osteodystrophy?

Answer 12

This is the bone destruction happening in secondary hyperpara. Not as potent as osteitis cystica. Has the rugged jersey sign.

Question 13

What do patients with calciphylaxis usually die from?

Answer 13

Infection/sepsis

Question 14

In evaluating a patient for high calcium, if the PTH is high what are we thinking? If it is low, what are we thinking? If PTH is high and calcium is low what are we thinking?

Answer 14

Primary
Malignancy or some other patho pathway like vitamin d
Secondary like renal failure

Question 15

2 lab features with CASR mutation and why?

Answer 15

Low calcium because the sensors are too sensitive so they shut off PTH.
High calcium in urine because the sensors are too sensitive in kidneys so they excrete too much calcium.