Endocrine Pathology - The Parathyroid Gland (easy) Flashcards
Causes of hypoparathyroidism
- congenital - DiGeorge syndrone
- aquired - complication of parathyroidectomy or thyroidectomy
- transient - neonates born prematurely
- inherited - pseudohypoparathyroidism or pseudopseudohypoparathyroidism
Signs and symptoms of hypoparathyroidism
- abdominal pain
- myalgia
- muscle spasm
- seizures
- fatigue
- headaches
- carpopedal spasm
- Chvostek’s sign
- Trousseau’s sign
Investigations for hypoparathyroidism
- PTH level
- Serum calcium
- Serum phosphate
- Bloods - FBC, U&Es, LFTs, creatinine, urea
- ECG - arrhythmias
- ECHO - cardiac sturctural defects (DiGeorge syndrome)
- Radiology - X-ray of hand (pseudohypoparathyroid patients have shorter 4th and 5th metacarpals)
Investigation results for hypoparathyroidism
Hypoparathroidism
- ↓PTH levels
- ↓serum calcium
- ↑serum phosphate
Pseudohypoparathyroidism
- ↑PTH levels
- ↓serum calcium
- ↑serum phosphate
Pseudopseudohypoparathyroidism
- PTH, serum calcium and serum phophate normal
Pathophysiology of hypoparathyroidism
PTH secretion is ↓ due to gland failure
Pathophysiology of pseudohypoparathyroidism
Failure of target cell response to PTH
Pathophysiology of pseudopseudohypoparathyroidism
The morphological features of pseudohypoparathyroidism but with normal biochemistry
Treatment for hypoparathyroidism
- Conservative: diet high in calcium and low in phophate
- Medical: calcium and vitamin D supplements
Complications of hypoparathyroidism
- Renal calculi
- Arrhythmias
- Cateract formation
- Dental problems
Causes of hyperparathyroidism
Primary
- Parathyroid adenoma
- Parathyroid hyperplasia
- Parathyroid carcinoma
- Drug induced eg lithium
Secondary
- Vitamin D deficiency
- Chronic kidney injury
Tertiary
- Prolonged secondary hyperparathyroidism
Signs and symptoms of primary hyperparathyroidism
Bones, moans, groans and stones
- Asymptomatic
- Bones eg pain, osteoporosis
- Moans eg depression, fatigue
- Groans eg myalgia
- Stones eg kidney stones
Signs and symptoms of secondary hyperparathyroidism
- Osteomalacia
- Rickets
- Renal osteodystrophy
Investigations for hyperparathyroidism
- PTH level
- serum calcium
- serum phosphate
- bloods - FBC, U&Es, LFTs, creatinine
- Urine calcium level
- DEXA (dual energy X-ray scan)
- radiology
- ultrasound scan of kidneys and neck
- plain X-ray (for bone changes)
- parathyroid gland biopsy
Investigation results for hyperparathyroidism
Primary
- ↑PTH level
- ↑serum calcium
- ↓serum phosphate
Secondary
- ↑PTH level
- ↓serum calcium
- ↑serum phosphate
Tertiary
- ↑PTH level
- ↑serm calcium
- ↓serum phosphate
Treatment for primary hyperparathyroidism
- Conservative
- Monitoring
- Increase oral fluid intake
- Medical
- Bisphosphonates
- Surgical
- Parathyroidectomy
