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Endocrinology > Disorders of the Parathyroid > Flashcards

Disorders of the Parathyroid Flashcards

1
Q

Characterized by chronic poorly regulated excessive secretion of PTH

Results in excessive secretion of calcium and phosphate by the kidneys

More frequent over the age of 50

3x more common in females

A

Hyperparathyroidism

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2
Q

Usually caused by a single parathyroid adenoma

A

Hyperparathyroidism

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3
Q

Familial in about 10% of cases

Associated with MEN I and IIa

A

Hyperparathyroidism

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4
Q

What are the types of hyperparathyroidism?

A

Primary
Secondary
Tertiary

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5
Q

Which type of hyperparathyroidism is described below?

Caused by hypersecretion of PTH, usually by a single parathyroid adenoma (80%), and less commonly by hyperplasia by two or more parathyroid glands (20%), or carcinoma (≤1%)

Occurs at all ages but more commonly in the 7th decade in women (~70s)

Most common cause of hypercalcemia in the outpatient setting

A

Primary hyperparathyroidism

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6
Q

Which type of hyperparathyroidism is described below?

Renal failure is the most common cause

Other causes include: Vit D deficiency, inadequate calcium intake or absorption

A

Secondary hyperparathyroidism

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7
Q

Which type of hyperparathyroidism is described below?

Results from autonomous functioning parathyroid glands in patients with long-standing secondary hyperparathyroidism

A

Tertiary hyperparathyroidism

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8
Q

What is the most common cause of hypercalcemia in the outpatient setting?

A

Primary hyperparathyroidism

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9
Q

What is the most common cause of secondary hyperparathyroidism?

A

renal failure

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10
Q

Excessive PTH spares which type of bone?

A

trabecular bone

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11
Q

What are some complications of severe chronic hyperparathyroidism?

A

Diffuse demineralization
Pathologic fracture
Cystic lesions throughout the skeleton

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12
Q

What are the clinical findings of hyperparathyroidism?

A

Stones
Bones
Groans
Moans
Overtones

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13
Q

What ocular findings might you see in cases of hyperparathyroidism?

A

Band keratopathy

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14
Q

Appearance of a band across the central cornea, formed by the
precipitation of calcium salts on the corneal surface directly under
the epithelium

A

Band keratopathy

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15
Q

What is the hallmark lab finding in hyperparathyroidism?

A

Hallmark is serum Calcium >10.5 mg/dL

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16
Q

If serum calcium is high in a patient, what is a confirmatory test to order for hyperparathyroidism?

A

PTH

Diagnosis confirmation: elevated levels of intact PTH

17
Q

List some differential diagnoses to consider when working up a patient with high levels of calcium

A

Artifact
Malignancy
Sarcoidosis or other granulomatous disorders
Exogenous intake
Familial benign hypocalciuric hypercalcemia
Vitamin D deficiency
Adrenal insufficiency
immobilization

18
Q

Indicated for the treatment of severe hypercalcemia in patients with
primary hyperparathyroidism who are unable to undergo parathyroidectomy

A

Cinacalcet (calcimimetic)

19
Q

In patients with parathyroidism, what patients is a parathyroidectomy required?

A

Parathyroidectomy often required for symptomatic patients with kidney stones, bone disease, and pregnancy

20
Q

List some factors where a parathyroidectomy would be the best treatment

A

Serum calcium 1mg/dL above upper limit of normal with urine calcium >50mg in 24 hours

Urine calcium >400mg/24hr

Cortical bone density > 2 SD below normal (wrist and hip)

Patients younger than 50

Pregnancy

Difficulty with follow up

21
Q

In patients with a parathyroid adenoma that is being monitored, what are the follow up guidelines?

A

Follow up every 6 months

Evaluate hypercalcemia symptoms

Ca, Phos, and albumin every 6 months

24 hour urine and creatinine yearly

Abdominal xrays yearly

Bone mineral density yearly

Adequate hydration

Avoid thiazide diuretics

Consider bisphosphonate therapy for prevention of osteoporosis

22
Q

In this endocrine condition, many patients are asymptomatic unless it’s chronic

A

Hypoparathyroidism

23
Q

List some causes for hypoparathyroidism

A

Acquired hypoparathyroidism
May occur from heavy metal damage
Granulomas
Tumors
DiGeorge syndrome
Infection
Redel thyroiditis
Magnesium deficiency
Malabsorption
Chronic alcoholism
Autoimmune (e.g. polyglandular autoimmunity Type 1)

24
Q

What is the most common cause of acquired hypoparathyroidism?

A

Thyroidectomy

25
Q

Serum levels of parathyroid hormone and what depend on each other in a complex manner?

A

magnesium

26
Q

Facial muscle contraction on tapping the facial nerve in front of
the ear

A

Chvostek Sign

27
Q

Carpal spasm after application of a blood pressure cuff

A

Trousseau Phenomenon

28
Q

What are some complications of hypoparathyroidism?

A

Seizures (common in untreated cases)

Kidneys issues due to overtreatment with Vit D and calcium

Chronic hypocalcemia (heart failure)

29
Q

In hypoparathyroidism, why should you be cautious with calcium supplementation?

A

Overtreatment with Vitamin D and calcium may produce nephrocalcinosis and impairment of renal function

30
Q

Emergency Treatment for Acute Attack (Hypoparathyroid Tetany) - what are is needed for these episodes?

A

Airway – have an adequate airway established

Intravenous calcium gluconate

Oral calcium

Vitamin D

Magnesium (if hypomagnesemia is present – must be corrected to
treat hypocalcemia)

Transplantation of cryopreserved parathyroid tissue removed during
prior surgery

31
Q

What pathophysiology is described below?

PTH resistance!

Defect in parathyroid hormone receptor

Calcium is low, PTH is high

A

Pseudohypoparathyroidism

32
Q

What condition is described below that resembles hypoparathyroidism?

May have similar resistance to TSH, FSH, LH

Short stature

Rounded faces

Short 4th and 5th metacarpals

A

Albright’s hereditary osteodystrophy

Endocrinology (7 decks)

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