Endocrine Disorders

Question 1

What condition is characterized by the excess secretion of PTH from one or more parathyroid glands?

Answer 1

Primary hyperparathyroidism

Question 2

What is the most common cause of primary hyperparathyroidism?

Answer 2

Parathyroid adenoma

Question 3

What gene mutation is implicated in some cases of parathyroid adenomas?

Answer 3

CASR gene

Question 4

In cases of primary hyperparathyroidism, PTH will remain elevated despite increasing ____ levels

Answer 4

Ca2+

Question 5

How does hyperparathyroidism affect bone?

Answer 5

• increased osteoclastic activity
• decreased osteoblastic activity

Question 6

How does hyperparathyroidism affect the kidneys?

Answer 6

• increased reabsorption of Ca
• increased excretion of phosphate
• increased calcitriol production

Question 7

What are some of the generalized signs and symptoms of Hypocalcemia?

Answer 7

• hyperactive reflexes
• spontaneous m. contractions
• convulsions
• laryngeal spasm w/ airway obstruction
• severe m. cramps
• mild tingling in hands and feet
• depression, paranoia, psychosis

Question 8

What physiological events occur in Dissecting osteitis?

Answer 8

• Osteoclasts are stimulated by the increased PTH levels
• Cutting cones into subperiosteal and endosteal surfaces of cortical bone
• Collagen is laid down adjacent to trabeculae

Question 9

What physiological events occur in Osteitis fibrosa?

Answer 9

• Accelerated bone remodeling
• Trabeculae is resorbed
• Bone marrow replaced by fibrous tissue, macrophages, areas of hemorrhage from microfractures, and reactive bone formation

Question 10

What physiological events occur in Osteitis fibrosa cystica?

Answer 10

• Brown tumors (geographic lytic lesion) develop which contain osteoclastic giant cells
• Visible bone changes on radiographic images

Question 11

What are some of the radiographic characteristics of Primary Hyperparathyroidism?

Answer 11

• Fractures
• Osteolysis
• “Lace-like” appearance of bone
• Loss of cortical line definition
• Appearance of brown tumors
• Soft tissue calcifications (metastatic)
• subperiosteal resorption
• subchondral resorption (later sign)

Question 12

What is the most common location of subperiosteal resorption?

Answer 12

radial aspect, middle phalanx, of 2nd & 3rd digits

Question 13

What are some of the clinical manifestations of a patient with primary hyperparathyroidism?

Answer 13

• Hypercalcemia (persistence leads to impaired renal function, eventual failure) -> Kidney stones
• Peptic ulcers (GI problems)
• MSK pain (wave-like back pain)
• Fracture
  (Stones, groans, moans, bones)

Question 14

What is the best treatment options for Primary Hyperparathyroidism?

Answer 14

Surgical removal of the parathyroid gland adenoma

Question 15

What condition is characterized by an increase in PTH secretion due to chronic renal failure?

Answer 15

Secondary Hyperparathyroidism

Question 16

What condition is characterized by a parathyroid hyperplasia and hypercalcemia from long-standing secondary hyperparathyroidism?

Answer 16

Tertiary Hyperparathyroidism

Question 17

What refers to the bone changes seen in patients with secondary/tertiary hyperparathyroidism due to end-stage kidney disease?

Answer 17

Renal Osteodystrophy

Question 18

What radiographic finding is associated with renal osteodystrophy in the spine?

Answer 18

Rugger-jersey spine

Question 19

How does hyperparathyroidism affect the intestines?

Answer 19

increased calbindin –> decreases vit D

Question 20

Hyperphosphatemia can lead to what conditions in soft tissues?

Answer 20

Metastatic calcifications

Question 21

What condition is commonly seen in dialysis patients that result in the bones to become more brittle and prone to fracture?

Answer 21

Adynamic variant of renal osteodystrophy (ARO)

Question 22

What are some of the treatment options for Secondary Hyperparaythyroidism?

Answer 22

• Treatment for renal failure
• Vitamin D supplementation
• Drug therapy to control phosphate levels

Question 23

What condition is characterized by the decreased PTH secretion?

Answer 23

Hypoparathyroidism

Question 24

What is the most common cause of Hypoparathyroidism?

Answer 24

Idiopathic parathyroid atrophy

Question 25

What conditions is characterized by a mutation of the GNAS1 gene that affects the PTH receptor of end organs leading to Hypocalcemia?

Answer 25

Psuedohypoparathyroidism

Question 26

What condition is a type of psuedohypoparathyroidism that results in a short stature, mental retardation, and short metacarpals and metatarsals?

Answer 26

Albright Hereditary Osteodystrophy

Question 27

What are the expected serum calcium levels in Primary Hyperparathyroid patients?

Answer 27

Elevated

Question 28

What are the expected PTH levels in Primary Hyperparathyroid patients

Answer 28

Elevated

Question 29

What are the expected serum phosphate levels in Primary Hyperparathyroid patients

Answer 29

Decreased

Question 30

What are the expected PTH levels in Secondary Hyperparathyroid patients?

Answer 30

Elevated

Question 31

What are the expected serum calcium levels in Secondary Hyperparathyroid patients?

Answer 31

Decreased

Question 32

What are the expected serum phosphate levels in Secondary Hyperparathyroid patients?

Answer 32

Elevated

Question 33

What are the expected PTH levels in Hypoparathyroid patients?

Answer 33

Decreased

Question 34

What are the expected serum calcium levels in Hypoparathyroid patients?

Answer 34

Decreased

Question 35

What are the expected serum phosphate levels in Hypoparathyroid patients?

Answer 35

Normal

Question 36

What are the expected serum calcium levels in Pseudohypoparathyroid patients?

Answer 36

Decreased

Question 37

What are the expected PTH levels in Psuedohypoparathyroid patients?

Answer 37

Elevated

Question 38

What are the expected serum phosphate levels in Pseudohypoparathyroid patients?

Answer 38

Normal

Question 39

What are the expected serum calcium levels in Hypervitaminosis D patients?

Answer 39

Elevated

Question 40

What are the expected PTH levels in Hypervitaminosis D patients?

Answer 40

Decreased

Question 41

What are the expected serum phosphate levels in Hypervitaminosis D patients?

Answer 41

Decreased

Question 42

What are the expected serum calcium levels in Osteomalacia patients?

Answer 42

Decreased

Question 43

What are the expected PTH levels in Osteomalacia patients?

Answer 43

Elevated

Question 44

What are the expected serum phosphate levels in Osteomalacia patients?

Answer 44

Decreased

Question 45

What is the most common cause of gigantism?

Answer 45

Somatotrope adenoma

Question 46

What condition is characterized by the increased secretion of Growth Hormone leading to enlargement of the extremities?

Answer 46

Acromegaly

Question 47

What condition is characterized by the hypersecretion of growth hormone during the early years of life?

Answer 47

Gigantism

Question 48

What endocrine condition leads to a symmetrical overgrowth in all tissues that can result in increased height?

Answer 48

Gigantism

Question 49

What is your biggest concern in patients with Gigantism?

Answer 49

Cardiovascular issues

Question 50

What are some of the clinical manifestations of patients with Gigantism/Acromegaly?

Answer 50

• Increased facial robusticity/coarsening of features
• Increased size of hands and feet
• Diabetes mellitus type 2 sequels
• Hypofunctioning pituitary gland
• Organ enlargement

Question 51

What is the best treatment options for patients with Gigantism/Acromegaly?

Answer 51

Pituitary adenoma removal

Question 52

TRUE or FALSE:
Somatotrope adenomas can lead to secondary reproductive issues due to pituitary hypofunctioning

Answer 52

True