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MRCP Endo > Hyperparathyroidism > Flashcards

Hyperparathyroidism Flashcards

1
Q

primary hyperparathyroidism what is seen on blood investigation ?

A

High calcium

High PTH levels OR INAPPROPRIATELY NORMAL

Low Phosphate

ALP increased

Renal stones

Urine calcium : creatinine clearance ratio > 0.01

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2
Q

indication for parathyroidectomy in primary hyperparathyroidism ?

A

nephrolithiasis

serum Calcium > 1mg/dL above normal

Hypercalciuria > 400mg/day

Creatinine clearance < 30% compared with normal

Episode of life threatening hypercalcaemia

Age < 50 years

Neuromuscular symptoms

Reduction in bone mineral density of the femoral neck, lumbar spine, or distal radius of more than 2.5 standard deviations below peak bone mas

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3
Q

Clinical features of Primary hyperparathyroidism

A

May be asymptomatic if mild

Or

Recurrent abdominal pain (pancreatitis, renal colic)

Changes to emotional or cognitive state

osteitis fibrosa cystica- loss of bone mass

Pseudogout - painful joints

Renal calcium stones

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4
Q

cause of Primary hyperparathyroidism

A

solitary adenoma (80%), multifocal disease occurs in 10-15% and parathyroid carcinoma in 1% or less

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5
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8
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Treatment of primary hyper parathyroidism

A

Parathyroidectomy

Ergocalcoferol / cholecalciferol

If osteoporosis - bisphosphonates

Cinacalcet - Cinacalcet has been shown to lower serum calcium and serum intact PTH.

may now be used in selected cases of primary hyperparathyroidism; for example, in those who are symptomatic but not surgical candidates or who decline surgery.

Kidney stones - thiazide diuretics

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9
Q

complication of hyperparathyroidism?

A

hypercalcemia - nephrogenic DI

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10
Q

cause of Secondary hyperparathyroidism

A

Parathyroid gland hyperplasia

result of low calcium, and high phosphate - setting of chronic renal failure

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11
Q

clinical features of Secondary hyperparathyroidism

A

Eventually may develop bone disease, osteitis fibrosa cystica and soft tissue calcifications

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12
Q

Secondary hyperparathyroidism what is seen on blood investigation ?

A

PTH (Elevated) therefore high ALP
Ca2+ (Low or normal)
Phosphate (Elevated)
Vitamin D levels (Low)

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15
Q

Indications for surgery in secondary (renal) hyperparathyroidism:

A

Bone pain
Persistent pruritus
Soft tissue calcifications

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18
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cause for tertiary hyperparathyroidism ?

A

autonomous secretion of PTH because of long standing secondary hyerparathryosism

= SEEN IN END STAGE RENAL DISEASE

after correction of underlying renal disorder, hyperplasia of all 4 glands is usually the cause

19
Q

clinical features of tertiary hyperparathyroidism

A

Metastatic calcification
Bone pain and / or fracture
Nephrolithiasis
Pancreatitis

20
Q

blood investigation for tertiary hyperparathyroidism ?

A 
Ca2+ (Normal or high)
PTH (Elevated)
Phosphate levels (Decreased or Normal)
Vitamin D (Normal or decreased)
Alkaline phosphatase (Elevated)
21
Q

benign familial hypocalciuric hypercalcaemia distinguished from primary hyperparathyroidism

A

urine calcium : creatinine clearance ratio <0.01

Diagnosis is usually made by genetic testing and concordant biochemistry (urine calcium : creatinine clearance ratio <0.01-distinguished from primary hyperparathyroidism)

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27
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management of tertiary hyperparathyroidism?

A

presence of an autonomously functioning parathyroid gland may require surgery. If the culprit gland can be identified then it should be excised. Otherwise total parathyroidectomy and re-implantation of part of the gland may be required.

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32
Q

in Paget disease there is only what in diagnoses ?

A

older male with bone pain and an isolated raised ALP
calcium and phosphate are typically normal. Hypercalcaemia may occasionally occur with prolonged immobilisation

33
Q

other markers of bone turnover include

A

procollagen type I N-terminal propeptide (PINP)
serum C-telopeptide (CTx)
urinary N-telopeptide (NTx)
urinary hydroxyproline

34
Q

Mx of paget disease

A

dications for treatment include:
bone pain
skull or long bone deformity
fracture
periarticular Paget’s
bisphosphonate (either oral risedronate or IV zoledronate)
calcitonin is less commonly used now

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40
Q

osteomalacia ?

A

Low serum calcium, low serum phosphate, raised ALP and raised PTH -

MRCP Endo (36 decks)

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