Hyperparathyroidism Flashcards
1
Q
Which cells secrete PTH?
A
- Chief cells in parathyroid gland
2
Q
What is the function of PTH?
A
- Increase plasma Ca
- increase osteoclast activity
- increase Ca reabsorption and phosphate secretion in kidney
- increase active vit D (calcitriol) production
3
Q
What is the alternative form of calcitriol?
A
1,25-dihydroxycholecalciferol
4
Q
What are the causes of hyperparathyroidism?
A
- Primary
- solitary tumour of parathyrid gland (common)
- hyperplasia
- Secondary
- CRF
- Vit D defficiency
- Tertiary
- prolonged secondary hyperparathyroidism
- Malignant hyperparathyroidism
- PTHrP by squamous cell lung cancer, breast cancer, renal cancer
5
Q
What are the Sx of hyperparathyroidism?
* remember stones, bones, groans, thrones and psychiatric moans
A
- Renal stones
- Bone pain
- N&V, constipation
- Fatigue, depression, psychosis
6
Q
What are the features of primary hyperparathyroidism?
A
- Sx
- asymptomatic (common)
- hyperparathyroidism sx
- high BP
- Ix
- high cal
- high PTH
- low phosphate
- Imaging
- osteitis fibrosa cystica
- Dexa - for osteoporosis
7
Q
What are the features of osteitis fibrosa cystica?
A
- subperiosteal erosions
- cyst
- brown tumours of phalanges
- acro-osteolysis
8
Q
What are the features of secondary hyperparathyroidism?
A
- High PTH
- low - normal Ca
9
Q
What are the features of tertiary hyperparathyroidism?
A
- High PTH
- High Ca
10
Q
How would you mx hyperparathyroidism?
A
- Primary and tertiary
- Surgically remove parathyroid gland
- Sedcondary
- treat underlying cause
11
Q
What are the features of malignant hyperparathyroidism?
A
- low PTH
- PTHrP not detected in assay
12
Q
What are the recommendation referral for consideration of parathyroid surgery?
A
- Symptoms of hypercalcaemia (e.g. thirst, polyuria, constipation)
- End-organ disease (renal calculi, fragility fractures or osteoporosis)
- Corrected serum calcium of 2.85 mmol/L or above
