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Year3 Endo Conditions > Hyperparathyroidism > Flashcards

Hyperparathyroidism Flashcards

1
Q

What is hyperparathyroidism?

A

overproduction of PTH

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2
Q

What happens if there are high levels of Ca2+ in blood to PTH?

A

decrease PTH level

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3
Q

What happens in primary hyperparathyroidism?

A

makes PTH independent of calcium level –hypercalcaemia and hypophosphatemia (Parathyroid adenoma)

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4
Q

What happens in secondary hypoparathyroidism?

A

makes excess PTH in response to chronic hypocalcaemia and hyperphospahtaemia and low Vit D

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5
Q

What happens in tertiary hyperparathyroidism?

A
  • secondary for a long time and hypercalcaemia – check if kidney transplant
  • same symptoms as primary and high phosphate levels
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6
Q

What are the causes for primary hyperparathyroidism?

A
  1. Solitary adenoma
  2. Hyperplasia of all glands
  3. Parathyroid cancer (rare)
    - sometimes Hx of osteoporosis and osteomalacia
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7
Q

What are the RF for primary hyperparathyroidism?

A
  1. Female sex
  2. Age >50-60years
  3. Family history of PHPT
  4. MEN 1, 2A or 4
  5. Current or historical lithium treatment
  6. Hyperparathyroidism-jaw tumour syndrome
  7. Hypertension
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8
Q

What are the causes of secondary hyperparathyroidism?

A
  1. Low Vit D intake
  2. Chronic renal failure
  3. Increased Age is RF
  4. Liver disease
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9
Q

Why might you have low vit D in secondary hyperparathyroidism?

A
  1. malabsoprtion e.g. IBD
  2. sunlight exposure
  3. genetic conditions
  4. medications
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10
Q

What happens anatomically in tertiary hyperparathyroidism?

A
  1. longed secondary hyperparathyroidism
  2. causing glands to act autonomously having undergone hyperplastic or adenomatous change
  3. this causes high calcium from very high secretion of PTH unlimited by feedback control
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11
Q

When is tertiary hyperparathyroidism usually seen?

A

chronic renal failure

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12
Q

What is malignant hyperparathyroidism?

A

parathyroid related protein (PTHrP) is produced by some squamous cell lung cancer breast and renal cell carcinoma

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13
Q

What are PTH levels like in malignant hyperparathyroidism?

A
  1. mimics PTH
  2. high calcium
  3. PTH is low
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14
Q

What are the symptoms and signs of primary hyperparathyroidism?

A
  1. Asymptomatic
  2. Weak
  3. Tired
  4. Depressed
  5. Thirsty
  6. Pain, fractures
  7. High BP
    - Bones, groans, abdominal moans
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15
Q

What are the symptoms and signs of secondary hyperparathyroidism?

A
  1. Muscle cramps and bone pain
  2. Renal osteodystrophy
  3. Calcification in blood vessel and soft tissues
  4. Fractures/bone pain
  5. Proximal myopathy
  6. Fatigue
  7. Hypocalcaemia:
    ”CATs go numb”
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16
Q

What are some DDx of primary hyperparathyroidism?

A
  1. Familial hypocalciuric hypercalaemia (FHH)
  2. Humoral hypercalcaemia of malignancy
  3. Multiple myeloma
  4. Milk-alkali syndrome
  5. Sarcoidosis
  6. Hypervitaminosis D
  7. Thyrotoxicosis
  8. Chronic or acute leukaemia
  9. Immobilisation
  10. Thiazide use
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17
Q

What are some DDx of secondary hyperparathyroidism?

A

primary hyperparathyroidism

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18
Q

What are complications of primary hyperparathyroidism?

A
  1. Neck haematoma following surgery
  2. Recurrent and superior laryngeal nerve injury following surgery
  3. Hypocalcaemia following surgery
  4. Pneumothorax following surgery
  5. Osteoporosis
  6. Bone fractures
  7. Nephrolithaisis
  8. Hypoparathyroidism
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19
Q

What are the complications of secondary hyperparathyroidism?

A
  1. Renal osteodystrophy
  2. Osteoporosis
  3. Calciphylaxis
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20
Q

What investigations are done for primary hyperparathyroidism and the levels?

A
  1. Serum calcium: high
  2. Serum PTH: high (or inapparopirately normal e.g. lithium, thiazide)
  3. Low PO43- (unless renal failure)
  4. High ALP
  5. 24 hour urinary calcium: high
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21
Q

What investigations are done for secondary hyperparathyroidism and what are the levels?

A
  1. Serum calcium: low
  2. PTH: high
  3. Serum creatinine
  4. Serum urea
  5. Low phosphate if Vit D def or high phopahte if CKD
  6. ALP High
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22
Q

What investigations are done for tertiary hyperparathyroidism and the levels?

A
  1. Serum calcium: high

2. PTH: very high

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23
Q

How do you manage mild primary hyperparathyroidism?

A
  1. High fluid intake to prevent stones
  2. Avoid thiazides
  3. Vit D supplement
  4. Monitor
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24
Q

How do you manage severe primary hyperparathyroidism?

A

parathyroidectomy

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25
Q

How do you manage secondary hyperparathyroidism?

A
  1. Treat cause
  2. Phosphate binder / dietary phosphate restriction
  3. Vit D
  4. Cinacalcet if PTH >85pmol/L
  5. UV radiation exposure
26
Q

What is the prognosis of primary hyperprarthyroidism?

A
  1. 8% recurrence in 10yrs
  2. parathyroidectomy: 95-97% cured
  3. observation over 10 years 25% end up needing parathyroidectomy
27
Q

What are the hormones that increase calcium?

A
  1. PTH

2. Calcitriol (activated Vit D) (1,25-(OH)2D3)

28
Q

What hormones are involved in synthesis?

A
  1. PTH (parathyroid glands)
  2. Calcitonin (parafollicular cells)
  3. Calcitrol (skin and UV light)
29
Q

What are extracellular Ca2+ levels sensed by?

A

parathyroid cell

30
Q

If clacium is low what should PTH do?

A

PTH should be released

31
Q

What hormones decrease calcium?

A

calcitonin

32
Q

What can calcitonin be used as?

A

a tumour marker in medullary thyroid cancer

33
Q

What is calcium metabolism?

A
  1. Vitamin D from diet and IV
  2. Gets formed into (25-OH)D3 by 25-hydroxylase in liver
  3. This with PTH and 1 alpha hydroxylase is used to form calcitriol in the kidneys
34
Q

What does increased PTH do to the kidneys?

A
  1. 1 alpha hydroxylase stimulation
  2. Increased calcium reabsorption
  3. Increase phosphate excretion
35
Q

What does increased PTH do to the bones?

A

Increased bone absorption

36
Q

What does increased PTH do to the small intestine?

A
  1. Increased calcium absorption

2. Increased phosphate absorption

37
Q

What is the overall effect of increased PTH?

A
  1. Increase calcium

2. V decreased phosphate

38
Q

What does calcitriol do to the kidneys?

A
  1. increased calcium reabsorption

2. Decrease phosphate reabsorption

39
Q

What does increased calcitrol do to the bones?

A
  1. Increased bone formation
40
Q

What does increased calcitrol do to the small intestine?

A
  1. Increased calcium absorption

2. Increase phosphate absorption

41
Q

What is the overall result of increased calcitriol?

A
  1. V increase in calcium

2. Increase in phosphate

42
Q

What are blood levels in primary hyperPTH?

A
  1. High calcium

2. Low phosphate

43
Q

What is secondary hyperPTH also known as?

A

osteomalacia

44
Q

What are blood levels of secondary hyperPTH?

A
  1. Low calcium
  2. Low phosphate (if vit D def)
  3. High Phosphate (if CKD)
45
Q

What are blood levels in tertiary hyperPTH?

A
  1. High calcium

2. High phosphate

46
Q

What are the causes of high calcium when PTH is high?

A
  1. Primary hyperPTH

2. Tertiary hyperPTH

47
Q

What are causes of high calcium when PTH is low?

A
  1. Malignancy (bone mtases, multiple myeloma, paraneoplastic (lung)
  2. Sarcoidosis
  3. Thiazide diuretics
    Hypercalcaemia can also cause pancreatitis
48
Q

What are causes of low calcium when PTH is high?

A

Secondary HyperPTH (Osteomalacia)

49
Q

What are causes of low calcium when PTH is low?

A
  1. Surgical complications (iatrogenic)

2. Auto-immune hypoparathyroidism

50
Q

Whhat is Trousseau’s sign?

A

inflation of cuff to high BP causes contraction of wrist and fingers

51
Q

What is Chvostek’s sign?

A

tapping facial nerve causes twitch of muscle fibres

52
Q

What are signs of secondary hyperPTH is children?

A
  • Bowed legs

* Knock knees

53
Q

What are endocrine causes of proximal myopathy?

A
  1. Cushing’s
  2. Osteomalacia
  3. Thyrotoxicosis
54
Q

What would XR findings be in primary hyperPTH?

A
  1. Subperiosteal bone resorption (radial aspects)
  2. Acro-osteolysis
  3. Pepper-pot skull
55
Q

What would XR findings be in secondary HyperPTH?

A
  1. Rachitic rosary of CXR (nodularity at costochondral junctions)
  2. Looser’s pseudofractures
56
Q

What is the Mx of acute hypercalcaemia in primary HyperPTH?

A
  • IV fluids

* Bisphosphonates (if calcium remains high)

57
Q

What is the 1st line management for primary hyperPTH?

A

total parathyroidectomy – risk of recurrent laryngeal nerve damage

58
Q

What is the medical treatment of primary hyperPTH?

A
  1. Medical (if unsuitable for surgery)
  2. Cinacalcet
  3. (drug class: calcimemetic)
59
Q

How do you treat acute hypocalcaemia in osteomalacia?

A

IV calcium infusion

(calcium gluconate) – also used in hyperK+

60
Q

How do you treat osteomalacia medically?

A
  • Calcium
  • Vitamin D (inactive –
  • ergocalciferol)
61
Q

How do you treat osteomalacia medically due to CKD?

A
  • Calcium
  • Vitamin D (active - alfacalcidol)
  • Treat CKD

Year3 Endo Conditions (33 decks)

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