Endocrine

Question 1

• Thyroid gland
• Parathyroid gland

Answer 1

• Regulates metabolism
• Regulates body’s calcium

Question 2

Kidney contains the enzyme _ that converts

Answer 2

• 1 alpha hydroxylase
• 25 hyrdoxy Vitamin D to 1,25 dihydroxy Vitamin D

Question 3

Vitamin D

Answer 3

• In the intestine, helps absorb Ca2+
• Must first be activated PTH

Question 4

Hypoparathyroidism: Hypocalcemia

Answer 4

Causes:
-Surgical removal of glands during thyroidectomy, DiGeorge Syndrome, and hereditary autoimmunity syndrome. -Hypoparathyroidism is most common cause of hypocalcemia. Others covered in other systems. Hypoparathyroid/Hypocalcemia Signs & Symptoms: • Neuropsych: Seizures, dementia, anxiety, depression, extrapyramidal symptoms (parkinsonism most common), papilledema • Neuromuscular: Paresthesia around mouth and fingers/toes, muscle stiffness, myalgia and spasms • CV: CHF, hypotension, prolongation of QT interval • Autonomic: Biliary colic, bronchospasm, diaphoresis • Other: Cataracts, dry coarse skin, hyperpigmentation, eczema, steatorrhea

Question 5

• Chvostek Sign

Answer 5

twitching of the facial muscles in response to tapping over the area of the facial nerve

In response to hypocalcemia

Question 6

• Trousseau’s Sign

Answer 6

• This increases the irritability of the nerves, and a flexion of the wrist and metacarpal phalangeal joints can be observed with extension of the interphalangeal joints and adduction of the thumb (carpal spasm).

Question 7

• Hyperparathyroidism: Hypercalcemia
  
  • Causes
  • Symptoms

Answer 7

• Causes
  
  • Primary hyperparathyroidism (high PTH)
  • Adenomas (associated with MEN 1)
  • Gland enlargement
  • Carcinoma
• Secondary hyperparathyroidism (low calcium causes high PTH)
  
  • Renal failure
  • VItamin D def
  • Malabsorption
• Symptoms
  
  • Lethargy, weakness, confusion, coma
  • Polyuria, dehydration, nocturia, renal stones, renal failure
  • Constipation, nausea, anorexia, gastric ulcer, pancreatitis
  • Syncope from arrhythmias

Question 8

Mnemonic to remember Hyperparathyroidism: Hypercalcemia

Answer 8

• Stones (renal or biliary)
• Bones (bone pain)
• Groans (abdominal pain, nausea, vomiting)
• Thrones (polyuria) resulting in dehydration
• Psychiatric overtones (Depression, anxiety, cognitive dysfunction, insomnia, coma)

Question 9

• Workup for hyperparathyroidism: hypercalcemia and treatment

Answer 9

• Workup
  
  • Serum Ca2+, albumin, Mg2+ and PTH
  • (If low Albumin, Ca2+ will need to be adjusted)
  • 24hr urine calcium
  • Workup for malignancy, genetic disorder,diet, etc
• Management
  
  • Monitor dietary and medication high in Ca2+ and Vitamin D
  • Keep well hydrated
  • Maintain physical activity
  • Surgery