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Robbins Pathology- Endocrine (Chapter 24) > Chapter 24- Parathyroid > Flashcards

Chapter 24- Parathyroid Flashcards

1
Q

What is the result of using PTH during surgery in the cause of parathyroid carcinoma

A

Does not go down during or after surgery

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2
Q

In the case of a solitary parathyroid adenoma, what is the effect on the other parathyroid glands

A

Usually shrunken, because the increased PTH production from the adenoma will cause a feedback and stop production from the other glands

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3
Q

What is the likely diagnosis with:

  • Low calcium
  • High PTH
A

-Secondary hyperparathyroidism

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4
Q

What is the pathogenesis of pseudohypoparathyroidism

A

-Receptors are resistant to PTH, so low levels of calcium even in the presence of high levels of PTH

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5
Q

Where are the parathyroid glands located

A

4 spots on the back of the thyroid

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6
Q

What are the histological findings in the cause of parathyroid hyperplasia

A

-Lack of adipocytes without a normal rim of parathyroid tissue

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7
Q

What is the usual histological finding in the cause of a parathyroid adenoma

A

Abnormal tissue right directly next to normal tissue

Abnormal tissue: will have the secretory Chief cells with a follicular architecture, absence of adipose cells

Normal: Will contain chief cells, oxyphil cells, and Adipocytes

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8
Q

What are the bodily responses to PTH release from the parathyroid glands

A
  • Calcium release from bone
  • Vitamin D production in the kidney
  • phosphate excretion form the kidney
  • Calcium absorption in the gut
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9
Q

What are the clinal presentations of a patient with Digeorge syndome

A
  • Lack of adaptive immunity (no thymus)
  • Cardiac abnormalities
  • Hypocalcemia (no parathyroids)
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10
Q

What is the major cause of primary hyperparathyroidism

A

Adenomas (85-95%)

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11
Q

What is the likely diagnosis with:

  • Low calcium
  • Low PTH
A

Hypoparathyroidism

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12
Q

What is the scan done to look for a parathyroid adenoma

A

Technetium scan of the parathyroid gland, where there will be an increased uptake if there is an adenoma

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13
Q

What is the telltale sign used to help differentiate parathyroid carcinoma

A

Metastasis***

  • Also invasion into adjacent tissues
  • Vascular invasion
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14
Q

What are the parathyroid tumors seen with mutations in MEN 1

A

Parathyroid adenomas

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15
Q

What is the meaning of the primary hyperparathyroidism saying renal stone

A

Nephrolithiasis

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16
Q

What is the meaning of the primary hyperparathyroidism saying psychic moans

A
  • Depression
  • weakness/fatigue
  • Seuzures
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17
Q

What are the causes of parathyroid hyperplasia

A
  • MEN syndromes can be present

- Secondary hyperplasia is most common *

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18
Q

Pathogensis of sarcoidosis causing hypercalcemia

A

Increases vitamin d producing, resulting in calcium absorption from the intestines

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19
Q

What are the potential abnormal causes of raised PTH

A
  • Hyperparathyroidism (most likely primary adenoma)

- Familial hypocalciuric hypercalcemia (hyper sensitive calcium sensing receptors)

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20
Q

What are the signs for hypocalcemia

A
  • Muscle cramps and spasms (tetany)
  • Trousseau sign (blood pressure cuff induces hand movements)
  • Chvostek sign (tapping trigeminal nerve induces a twitch)
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21
Q

What are the causes of secondary hyperparathyroidism

A
  • Renal failure (cant convert to Vit D)
  • Vitamin D deficiency
  • Pseudohypoparathyroidsm
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22
Q

What are the general findings in osteitis fibrosis cystica

A
  • Starts as a cystic brown tumor***
  • Osteoclasts bone destruction
  • Small Fractures
  • Hemorrhae and reactive tissue
23
Q

What are the congenital conditions commonly leading to hypoparathyroidism

A
  • Digeorge syndrome
  • CASR germline mutations
  • Familial isolated hypoparathyroidism
24
Q

What is the likely diagnosis with:

  • High Calcium
  • Low PTH
A
  • Humoral hypercalcemia of malignancy

- other PTH independent cause

25
Q

What is renal osteodystrophy

A

Dissecting osteitis in secondary hyperparathyroidism, in which loss of bone density

26
Q

What are the potential abnormal causes of decreased PTH

A
  • Hypercalcemia of malignancy (PTHrP or a PTH analog from a malignancy is being produced)
  • Vitamin D toxicity
  • Immobilization
  • Granulomatous disease (sarcoidosis)
  • Thiazide diuretics
27
Q

When there is hyperparathyroidism due to anything other than a primary cause, what is the end result

A

Multifocal hyperplasia of the parathyroid glands

28
Q

What is the pathogensis of familial isolated hypoparathyroidism

A

Precursor PTH can not become functional, resulting in hypoparathyroidism

29
Q

What are the causes of tertiary hypocalcemia

A

Autonomous function of the parathyroud gland due to prolonged hypocalcemia

30
Q

What are the common causes of local osteolytic hypercalcemia

A

Breast carcinomas

Myeloma

31
Q

What are the general causes of symptomatic hypercalcemia

A

Malignancy***

32
Q

What is the pathogenesis of local osteolytic hypercalcemia

A

Release of calcium from bone aka osteoclastic bone resorption

33
Q

What are the tumors commonly causing PTHrP release

A

Most common tumor

  • Breast
  • Lung
  • non-Hodgkin lymphoma
34
Q

What is the product of chief cells in the parathyroid

A

PTH

35
Q

What is the likely diagnosis with:

  • high calcium
  • high PTH
A

-Primary or tertiary hyperparathyroidism

36
Q

What is the meaning of the primary hyperparathyroidism saying painful bones

A
  • Osteoporosis

- Osteitis fibrosis cystica

37
Q

What is the pathogenesis of Digeorge syndrome in development of hypoparathyroidism

A

-Defects in the 3rd and 4th pharyngeal ouches and the parathyroid glands are missing or underdeveloped

38
Q

What is the consequence of caciphylaxis

A

Occlusion of blood vessels that result in ischemia, leading to gangrene and sepsis

39
Q

What can be monitored during surgery to help predict a successful parathyroidectomy

A

PTH levels, as their short half life will give an indication in as little as 15 minutes

40
Q

What are the cell types histologically present in normal parathyroid tissue

A
  • Chief cells
  • Oxyophil cells
  • Adipocytes
41
Q

What is a cause of the calciphylaxis

A

Secondary hyperparathyroidism, especially renal disease

42
Q

What form of MEN1 is more common

A

Sporadic, but there is a familial aspect

43
Q

What is the effect of parathyroid on other parathroid glands

A

Almost always find parathyroid hyperplasia in multiple glands

44
Q

How does renal disease cause hyperparathyroidism

A

Kidneys can not secrete the phosphate, so therefore there is more in the blood, and more must be removed from the bones and absorbed to compensate

45
Q

How are most osteitis fibrosis cystica cases found

A

IN the asymptomatic phase

46
Q

What are the 4 sayings for hyperparathyroidism

A
  • Painful bones
  • Renal stone
  • Abdominal groans
  • Psychic moans
47
Q

What is the pathogenesis of humoral hypercalcemia of malignancy

A

Overall are hypoparathyroid conditions:
1-PTH analog PTHrP mediated as it is released from squamous carcinomas
2-Vitamin D mediated as it is released from lymphomas and acts to inhibit PTH release and greatly increases intestinal calcium uptake

48
Q

What is the classical finding in Renal osteodystrophy

A

Rugged jersey sign, in which the spinal vertebrae will look less dense than normal with large spaced between them

49
Q

What is the cardiovascular effect of primary hyperparathyroidism

A

Heart valve calcification

50
Q

What is the pathogenesis of CASR germline mutations

A

Aka familial hypocalcemia hypercalciuria:

  • Hypersensitive Calcium receptors (thinks low calcium levels are normal)
  • Causes decreased PTH and causes both hypoparathyroidism and hypocalcemia
51
Q

What is the meaning of the primary hyperparathyroidism saying abdominal groans

A
  • Constipation

- Gallstones

52
Q

What is the general cause of asymptomatic hypercalcemia

A

Primary hyperparathyroidism

53
Q

What is the pathogenesis of calciphylaxis

A

Sencondary hyperparathyroidism leads to calcification and occlusion of blood vessels that causes ischemia

Robbins Pathology- Endocrine (Chapter 24) (5 decks)

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