Hyperparathyroidism

Question 1

primary hyperparathyroidism?

Answer 1

tumour of parathyroid glands

Question 2

pTH is formed by?

Answer 2

chief cells

Question 3

what does PTH do?

Answer 3

increase absorption form intestines and calcium, and increasing osteoclast activity, converts vit D to its active form

Question 4

primary hyperparathyroidism causes?

Answer 4

high calcium

Question 5

what causes 2 hyperparathyroidism?

Answer 5

less vit D, chronic renal failure

Question 6

in 2 hyperparathyroidism levels would be?

Answer 6

low/normal calcium high PTH

Question 7

3 hyperparathyroidism?

Answer 7

caused by 2 hyperparathyroidism happening for a long time, hyperplasia, increased levels of PTH, remove secondary cause. high PTH, high calcium

Question 8

signs of hypercalcaemia?

Answer 8

kidney stones painful bones abdominal groans and psychiatric moans

Question 9

xray findings of primary hyperparathyroidism?

Answer 9

pepperpot skull
osteitis fibrosa cystica

Question 10

conservative management for primary hyperparathyroidism will only be offered when?

Answer 10

ca level less than 0.25 above upper limit of normal, over 50 years and no end-organ damage

Question 11

patients not suitable for surgery can be treated with?

Answer 11

cinacalcet- mimics calcium action on tissues

Question 12

cause of hypoparathyroidism?

Answer 12

surgery

Question 13

levels in hypoparathyroidism?

Answer 13

low calcium, PTH and high phosphate

Question 14

treatment of hypoparathyroidism?

Answer 14

alfacalcidol

Question 15

symptoms of hypoparathyroidism secondary to hypocalcaemia?

Answer 15

tetany: muscle twitching, cramping spasm, perioral paraesthesia, trousseau signs, Chvosteks signs, rolonged QT interval, depression cataracts

Question 16

positive trousseaus sign?

Answer 16

carpopedal apasm flexion of wrist, thumb and MCP when cuff inflated above systolic 3 mins

Question 17

positive chvosteks sign?

Answer 17

twitch of facial muscle after gently tapping cheek

Question 18

hypocalcaemia ECG changes?

Answer 18

prolonged QT interval

Question 19

pseudohypoparathyroidism?

Answer 19

target cells insensitive to PTH, due to abnormality in g protein. low calcium, high PTH, high phosphate

Question 20

diagnosis of pseudohypoparathyroidism?

Answer 20

urinary cAMP and phosphate levels. in hypoparathyroidism rise in CAMP and phosphate. in pseudohyoparathyroidism 1 no rise, in pseudohypoparathyroidism 2 rise only inCAMP levels

Question 21

what is pseudohypoparathyroidism associated with?

Answer 21

low IQ, short stature shortened 4/5th metacarpals

Question 22

PTHrp?

Answer 22

secreted from cancer cells (squamous cell bronchial carcinoma) but cannot activate vitamin D

Question 23

PTH actions?

Answer 23

1. osteoclast activity increases
2. activation of vit d in kidney
3. calcium reabsorption/ phosphate excretion