Disorders of the Parathyroids

Question 1

what is the most common cause of acquired hypoparathyroidism?

Answer 1

post-surgical of thyroid, parathyroid, or radical neck surgery

Question 2

what is the cause of hypoparathyroidism that is associated with function?

Answer 2

low magnesium

parathyroids need magnesium to function

Question 3

what is the hallmark presentation of acute hypoparathyroidism? why?

Answer 3

tetany
hypocalcemia

Question 4

twitch of the facial muscles when gently tapping an individuals cheek

Answer 4

chvostek sign

Question 5

spasm of hand induced by inflation of a BP cuff around the arm

Answer 5

Trousseau sign

Question 6

a patient presents with chvostek sign, trousseau sign, muscle cramps, stridor, cramps in hands and feet, seizures, and hyperactive deep tendon reflexes. what are they likely experiencing?

Answer 6

severe tetany due to hypopharathyroidism

Question 7

why would we order a total calcium AND a corrected calcium?

Answer 7

low calcium may be due to hypoalbuminemia

we want to only look at unbound calcium

Question 8

what would labs in a patient with hypoparathyroidism look like? PTH, serum calcium, serum phosphate, urinary calcium, magnesium.

Answer 8

low PTH
low serum total calcium
high serum phosphate
low urinary calcium
+/- low magnesium

Question 9

what is the emergency treatment for patients with + chvostek/trousseau seizures, arrhythmias, and calcium less than 7.5? (5)

Answer 9

airway
IV calcium
oral calcium ASAP
vitamin D
magnesium

Question 10

what is the goal in treating mild cases of hypoparathyroidism?

Answer 10

relieve symptoms + maintain serum Ca low-normal to avoid hypercalciuria

Question 11

what is the treatment for a patient with mild hypoparathyroidism? (3)

Answer 11

oral calcium
oral vit D (calcitriol)
+/- magnesium

Question 12

what medication can patients take if they have a severe case of hypoparathyroidism, but are not responsive to initial treatment?

Answer 12

Teriparatide (synthetic human PTH) - SubQ

Question 13

how often should we monitor urinary/serum calcium and serum phosphate after treating a patient for hypoparathyroidism? (2)

Answer 13

weekly until stable serum calcium

3-6 month intervals

Question 14

what is our first concerning sign after treating a patient for hypoparathyroidism?
what can it lead to? (3)

Answer 14

hypercalciuria

nephrolithiasis
nephrocalcinosis
renal failure

Question 15

where does the problem occur in primary hyperparathyroidism?

Answer 15

parathyroid glands

Question 16

what is the most common cause of primary hyperparathyroidism?

Answer 16

single parathyroid adenoma

Question 17

what is the second most common cause of primary hyperparathyroidism?

Answer 17

hyperplasia of 2+ parathyroid glands

Question 18

what is the most common cause of asymptomatic hypercalcemia?

Answer 18

primary hyperparathyroidism

Question 19

what are some possible consequences of asymptomatic hypercalcemia? why?

Answer 19

hypercalcuria + renal calculi

renal tubules unable to reabsorb all the calcium

Question 20

what is the relationship between PTH and bones?

Answer 20

PTH stimulates osteoclasts to break down bone

Question 21

what does excessive PTH lead to, in relation to bones?

Answer 21

cortical demineralization

Question 22

where in the body is cortical demineralization most common in?

Answer 22

hip and wrist

Question 23

where does the problem occur in secondary/tertiary hyperparathyroidism?

Answer 23

kidney

Question 24

what is the major cause of secondary/tertiary hyperparathyroidism?

Answer 24

chronic kidney disease

Question 25

what occurs in chronic kidney disease to cause hyperparathyroidism? (secondary)

Answer 25

kidneys cannot reabsorb calcium
increased PTH secretion in an attempt to create more calcium

Question 26

what occurs in secondary hyperparathyroidism?

Answer 26

parathyroid stimulation + enlargement

Question 27

what occurs in tertiary hyperparathyroidism?

Answer 27

parathyroid glands act as an adenoma, not responding to any levels of calcium - just continue dumping PTH

Question 28

a patient presents with low bone density, arthralgias, nephrolithiasis, abdominal groans, fatigue, depression, weakness, and bradycardia. what are they likely experiencing?

Answer 28

hyperparathyroidism

Question 29

what would labs look like in primary hyperparathyroidism? (4)

Answer 29

elevated serum/urine calcium
elevated PTH
low-normal serum phosphate
normal-elevated Alk Phos

Question 30

what does an elevated Alk Phos mean?

Answer 30

increased bone breakdown due to increased PTH = stimulating osteoclast activity

Question 31

what would labs look like in secondary hyperparathyroidism? (2)

Answer 31

low-normal serum calcium
elevated PTH

Question 32

when is imaging for hyperparathyroidism indicated?

Answer 32

pre-op to visualize adenomas

Question 33

what imaging is used to view osteopenia, cystic lesions, brown tumors, and salt and pepper skull in hyperparathyroidism?

Answer 33

xray

Question 34

what imaging is used to view nephrolithiasis in hyperparathyroidism?

Answer 34

ultrasound

Question 35

what imaging is used to determine bone loss in hyperparathyroidism?

Answer 35

DXA scan

Question 36

what is the treatment for a patient with hyperparathyroidism that is symptomatic or meets the asymptomatic guidelines?

Answer 36

parathyroidectomy

Question 37

what is the treatment for a patient with hyperparathyroidism that is symptomatic but a poor surgical candidate?

Answer 37

cinacalet - severe hypercalcemia

Question 38

what drug can be added for a patient with hyperparathyroidism that has osteoporosis?

Answer 38

bisphosphonates

Question 39

what are 3 things a patient with hyperparathyroidism should avoid?

Answer 39

thiazide diuretics
calcium supplements
immobilization/bed rest

Question 40

what can be reversed when primary hyperparathyroidism is cured? (2)

Answer 40

osteoporosis
osteopenia