Hyper/hypo PTH

Question 1

What is hyperparathyroidism?

Answer 1

High levels of PTH

Question 2

How many causes of hyperPTH are there?
Which is MC?

Answer 2

1^, 2^ and 3^
1 = MC

Question 3

What is the 1^ cause?

Answer 3

Usually parathyroid adenoma (sometimes PTH hyperplasia)
HyperPTH = HyperCa2+

Question 4

What is the 2^ cause?

Answer 4

Physiological response to low Ca+ conc
compensatory hypertrophy of all glands
CKD + Vit D deficiency
HypoCa+ = HyperPTH

Question 5

What is the 3^ cause?

Answer 5

After many years of 2^ hyperPTH (MC - CKD), glands act autonomously and release PTH, no negative feedback
(High PTH regardless of Ca2+ conc)

Question 6

How does malignancy cause hyperPTH?

Answer 6

Neoplasma (SCLC, breast, renal) secrete PTHrP , ectopically mimics PTH

Question 7

Sx of HyperPTH?

Answer 7

Bones - excess resort = osteopenia
Stones - kidney stones - calcium oxalate
Groans = abdo pain and constipation
Psychedelic moans = depression, anxiety

Question 8

What is the diagnostic for diagnosing hpyerPTH?

Answer 8

High PTH levels

Question 9

For 1,2 and 3^ HyperPTH
Type?
Cause?
PTH?
[Ca2+]?
[Phosphate]?
[ALP]?
Tx?

Answer 9

1^
Tumour
High
Very high
Low
High
Surgery

2^
Vit D def or CKD
high
low
high
high
Vit D suppose or transplant

3^
Hyperplasia after 2^
High
high
high
high
Surgery

Question 10

What other tests may be done?

Answer 10

Xray KUB - renal stones
DEXA scan - bone density
U+Es - assess renal function

Question 11

What does ECG show?

Answer 11

Short QT (hypercalcemia)

Question 12

Tx for 1, 2, 3^ and malignant?

Answer 12

1^ remove PTH adenoma/parathyroidectomy
2 and 3^ = Treat underlying cause
Malignant = remove tumour

Question 13

Complication of hyperPTH?

Answer 13

Acute severe hypercalcemia

Question 14

Tx for hypercalcemia?

Answer 14

IV fluids and bisphosphonates

Question 15

Which is rarer, hyper/hypo PTH?

Answer 15

HypoPTH

Question 16

What is HypoPTH?

Answer 16

Low PTH production

Question 17

How many causes are there?
Which is MC?

Answer 17

1^
2^ = MC
pseudohypoPTH

Question 18

What causes 1^?

Answer 18

PTH gland failure
Idiopathic
Di George syndrome = familial, PTH glands not developed (rare)

Question 19

What causes 2^?

Answer 19

After surgery (parathyroid/thyroidectomy) = MC

Question 20

What is pseudoHypoPTH?

Answer 20

Peripheral PTH resistance
Short stature + small 4th/5th metacarpals

Question 21

Sx of hypoPTH?

Answer 21

CATs go numb
Convulsions, Arrhythmias, tetany (involuntary contraction of muscles), Numbness

Question 22

What are 2 signs of HypoPTH?

Answer 22

Chvostek’s sign (twitching facial muscles when CN7 tapped over parotid)

Trousseau (carpopedal spasm) - when applying tourniquet to forearm

Question 23

Dx of HypoPTH?

Answer 23

Low PTH
Low Ca2+
High phosphate
ECG = Long QT

Question 24

Tx?

Answer 24

Calcium supplements and Vit D3 (AdCal D3)