Disorders of Ca and PT gland

Question 1

Where are CaSR found?

Answer 1

PT, kidney, C cells, bone

Question 2

Causes for hypercalcemia

Answer 2

MISHAP (malignancy, intox of VD, sarcoidosis, hyperpara, alkali, pagets

Also Familial hypocalciuric hypercalcemia or meds induced (lithium or HCTZ)

Question 3

Etiology of primary hyperparathyroidism

Answer 3

80-85% adenoma
15% hyperplasia (MEN1, MEN2A)
<1% carcinoma

Question 4

Epidemiology of hyperparathyroidism

Answer 4

women, AA>W>H

Question 5

Pt with hypercalcemia have what symptoms?#

Answer 5

stones, bones, groans psychiatric overtones

Question 6

What happens to hyperparathyroid in post-kidney transplant or end-stage renal disease

Answer 6

Glands become hyperplastic and autonomous

Question 7

What will PTH be in hypercalcemia due to malignancy and granulomatous disease?

Answer 7

Suppressed

Question 8

Initial treatment of acute hypercalcemia

Answer 8

address volume status. Calcitonin, bisphosphonates, GC,

Question 9

What are the major causes of secondary PTH elevation?

Answer 9

Hypocalcemia, hyperphosphatemia, VD deficiency

Question 10

What happens to VD in renal disease?

Answer 10

decrease 1a hydroxylase- decreased active VD

Question 11

____% of pt with osteoporosis have VD deficiency

Answer 11

50

Question 12

Clinical signs of hypocalcemia

Answer 12

trousseaus, chvosteks, hyperreflexia, agitation, convulsions, hypertension, long QT

Question 13

What are causes of primary hypoparathyroidism?

Answer 13

post-thyroidectomy, idiopathic, autoimmune, agenesis (DiGeroge), hypomagnesaemia, hypermag, hyperphosph

Question 14

Miscellaneous causes of hypocalcemia

Answer 14

acute pancreatitis, massive transfusion, tumor lysis, severe sepsis, meds, hungry bone syndrome

Question 15

What is the clinical manifestation of pseudohypoparathyroidism?

Answer 15

elevated PTH, hypocalcemia, hyperphosphatemia, short stature, round face, knuckle knuckle dimple dimple (esp 4th), obesity, Albright’s hereditary osteodystrophy

Question 16

What is the molecular defect for pseudohypoparathyroidism?

Answer 16

inability of PTH to stimulated intracellular events

Question 17

Should we memorize pseudohypoparathyroidism classifications?

Answer 17

Nah.

Question 18

Tx of acute hypocalcemic crisis?

Answer 18

correct mg. Calcium gluconate

Question 19

Timeline of MEN1 phenotype

Answer 19

Hypercalcemia by age 40. Pituitary tumors between 12 and 38. Insulinomas at 25. Gastrinoma at 35

Question 20

Crazy looking tongue is a clinical feature of ____.

Answer 20

MEN2B (mucosal neuromas)