CCs - in brief

Question 1

How does parathyroid adenoma present?

Answer 1

Causes primary hyperparathyroidism
Many are asymptomatic
High Ca2+ on routine tests
Weak, tired
Thirst
Dehydrated but polyuric
Bone symptoms eg pain, osteoporosis, fractures

Question 2

How is primary hyperparathyroidism defined?

Answer 2

Excessive PTH secretion from one or more glands

Question 3

What defines a parathyroid adenoma? (as opposed to carcinoma)

Answer 3

Encapsulated benign neoplasm of parathyroid cells

Single enlarged gland, remaining glands remain small and suppressed

Question 4

When is PTH normally secreted?

Answer 4

In response to low calcium levels

Overall effect is an increase in calcium and decrease in phosphate levels

Question 5

How is secondary hyperparathyroidism defined?

Answer 5

Low Ca2+ causes hyperplasia of glands and elevated PTH

Caused by renal insufficiency, malabsorption, vit D deficiency

Question 6

How is tertiary hyperparathyroidism defined?

Answer 6

Occurs after longstanding secondary hyperparathyroidism
Glands act autonomously having undergone hyperplastic change
Causes high calcium caused by inappropriately high PTH secretion

Question 7

What is Addison’s disease?

Answer 7

Adrenal insufficiency
Rare but fatal
Destruction of adrenal cortex –> cortisol and aldosterone deficiency

Question 8

What causes Addison’s?

Answer 8

80% due to autoimmunity
TB
Adrenal metastases
Lymphoma
Opportunistic infections in HIV

Question 9

How does Addison’s present?

Answer 9

"Lean, tanned, tired, tearful"
Anorexia
Dizziness
Faints
Flu-like myalgia / arthralgia
Think of Addison's in all with unexplained abdo pain / vomiting

Question 10

What would you expect to find on investigation of Addison’s?

Answer 10

Low Na+
High K+
Low glucose

Question 11

What is secondary adrenal insufficiency caused by?

Answer 11

Iatrogenic - due to long-term steroid therapy

Causes suppression of pituitary-adrenal axis