Hyperparathyroidism

Question 1

What is PTH released in response to

Answer 1

Low Ca2+

Question 2

What effects does PTH have (3)

Answer 2

Increased Ca2+ and decreased PO43- reabsorption in kidneys
Increasing activated 1,25 dihydroxy vit D3
increased osteclastic acitivity (^Ca2+ and ^PO43-)

Question 3

What is the overall effect on ions of PTH

Answer 3

lowered PO43-

Higher Ca2+

Question 4

What are the 3 signs of primary hyperparathyroidism

Answer 4

^ca2+
Bone resorption
Increase BP

Question 5

What are the clinical signs relating to ^Ca2+

Answer 5

Tiredness
Depressed
DEHYDRATED BUT POLYURIC
renal stones
Polydipsia

Question 6

What are the clinical signs relating to ^bone resorption

Answer 6

Pain, fractures, osteopenia/malacia/porosis

Question 7

Ix for primary hyperpara

Answer 7

Ca
PTH
Alk Phos (bone)
PO43-

Question 8

What may be evident on x-ray imaging

Answer 8

Pepper-pot skull
cysts
erosions (esp at phalanges)

Question 9

Mx for mild hyperparathyroidism (dietary advice)

Answer 9

increase fluid intake to prevent stones

Avoid Ca and vit d

Question 10

Mx for symptomatic hyperparathyroidism

Answer 10

Excision

Question 11

Medical Mx

Answer 11

CINACALCET

Question 12

MOA of Cinacalcet

Answer 12

Calcimimetic that increases the sensitivity of PT glands to Ca causing decreased secretion of PTH)

Question 13

Causes of 2ry Hyperparathyroidism

Answer 13

Chronic Renal failure

Decreased Activated Vit D (decreased intake/production)

Question 14

Explain tertiary hyperparathyroidism

Answer 14

prolonged 2ry causing gland hyperplasia and autonomy regardless of Ca concentration. ^Ca and ^PTH

Question 15

What cancers produce malignant hyperparathyroidism (3)

Answer 15

Squamous lung,
breast
renal

Question 16

What do malignant hyperpara tumours produce

Answer 16

PTHrP (parathyroid hormone related protein) (mimics PTh)