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Endocrine > EXAM #1: PATHOLOGY OF THE PARATHYROID > Flashcards

EXAM #1: PATHOLOGY OF THE PARATHYROID Flashcards

1
Q

What is the most common cause of primary hyperparathyroidism?

A

Parathyroid adenoma

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2
Q

How is the production of PTH described in a parathyroid adenoma?

A

Autonomous overproduction of PTH

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3
Q

What is the net effect of of overproduced PTH?

A

Hypercalcemia

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4
Q

How does overproduction of PTH cause hypercalcemia?

A

1) Increased bone resorption of Ca++
2) Increased renal tubular reabsorption of Ca++
3) Increased urinary EXCRETION of phosphate*
4) Increased synthesis of Vitamin D

PTH= Phosphate Trashing Hormone

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5
Q

What is the typical urine Ca++ finding in primary hyperparathyroidism?

A

Hypercalciuria

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6
Q

What is the sequelae of hypercalciuria in primary hyperparathyroidism?

A

Renal stones causing:

  • Flank pain
  • Hematuria
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7
Q

What are the major clinical manifestations of primary hyperparathyroidism?

A

1) Stones
2) Bones= osteomalacia (softening of the bones) then pathologic fracture/ “brown tumor”
3) Groans= gastritis/ gallstones
4) Moans= psych

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8
Q

What is another name for a Brown Tumor?

A

Osteitis fibrosa cystica

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9
Q

Why does primary hyperparathyroid cause abdominal pain?

A
  • Hypercalcemia stimulates gastrin release and acid secretion
  • Results in PUD
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10
Q

Grossly, is a parathyroid adenoma singular or multinodular? How big are these tumors?

A

Singular and between 0.5-5 grams

*Note that this is opposite of hyperplasia, where all four glands are bigger

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11
Q

What patient population is a parathyroid adenoma most common in?

A

Older women

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12
Q

What is the name of the surgical procedure to remove a parathyroid adenoma?

A

MIRP, Minimally-Invasive Radioguided Parathyroidectomy

*Utilizes Tc99 sestamibi

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13
Q

Describe the histologic appearance of parathyroid adenoma.

A
  • Dominance of chief cells with no fat/stromal cells

- Outlined by a thin rim of normal parathyroid

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14
Q

What is the second most common cause of primary hyperparathyroidism?

A

Parathyroid hyperplasia

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15
Q

How does parathyroid hyperplasia differ from a parathyroid adenoma?

A

All four glands are big

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16
Q

What does MEN stand for? What are the MEN syndromes?

A

Multiple Endocrine Neoplasia

*This is parathyroid disease with tumors of other endocrine organs

17
Q

Histologically, what is the difference between a parathyroid adenoma and hyperplasia?

A
  • There is NO RIM OF NORMAL tissue in parathyroid hyperplasia
  • Like adenoma, no fat cells as well
18
Q

What is secondary hyperparathyroidism?

A

Parathyroid hyperplasia due to HYPOCALCEMIA from other causes

19
Q

What is the most common cause of secondary hyperparathyroidism?

A

Chronic Renal Failure (CRF)

20
Q

Why does CRF cause hypocalcemia?

A
  • Abnormal renal loss of Ca

- Decreased renal conversion to 1,25(OH) 2 D

21
Q

What thyroid cancer is associated with secondary hyperparathyroidism?

A

Medullary carcinoma of the thyroid

22
Q

What oncogene mutation is associated with Medullary Carcinoma of the Thyroid?

A

RET

23
Q

What drug is indicated for patients with secondary parathyroidism due to renal pathology?

A

Calcitriol–the active metabolite of Vitamin D

24
Q

What is the surgical procedure to treat parathyroid carcinoma?

A

En bloc resection

25
Q

Histologically, what is the most common finding in parathyroid carcinoma?

A

Thick fibrous bands

26
Q

Grossly, how does a parathyroid carcinoma appear?

A

Gray-white irregular mass

*Note that this is over 10 grams

27
Q

List three common causes of hypoparathyroidism?

A

1) Iatrogenic during thyroidectomy
2) Autoimmune disorder
3) DiGeorge Syndrome

28
Q

What are the symptoms of hypoparathyroidism?

A

1) Mental status changes
2) Paresthesias
3) Chovstek sign
4) Trousseau sign
5) Convulsions
6) Tetany

29
Q

What are two clinical manifestations of tetany?

A
  • Risus sardonicus

- Opisthotonus

30
Q

What labs confirm the diagnosis of hypoparathyroidism?

A
  • Decreased Ca++

- Increased Phosphate

31
Q

What is the treatment for hypoparathyroidism?

A

1) Vitamin D
2) Calcium gluconate*
3) Recombinant human PTH

*Reduces the excitability of cardiac myocytes and is thus cardioprotective in hyperkalemia

Endocrine (34 decks)

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