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Endocrine > Hyperparathyroidsim > Flashcards

Hyperparathyroidsim Flashcards

1
Q

Bloods in hyperparathyrodism

A

Hyponatremia
High corrected calcium
Low phosphate
PTH ABNORMALLY normal - should be low
normal vit D

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1
Q

What is primary hyperparathyroidism normally caused by

A

primary adenoma of the parathyroid gland.

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2
Q

Bloods in secondary hyperparathyroidsim

A

LOW calcium
HIGH PTH
Vit D low
High phosphate
Abnormal electrolytes

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3
Q

Why does CKD cause 2ndry hyperparathyroidsims

A

Nephron fails -> phosphate build up - osteocytes work to release FGF23 excrete more phosphate BUT also reduces calcium absorption in gut and reduces calcium release from bones -> LOW
More PTH produced by body

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4
Q

Bloods in tertiary hyperparathyroidism

A

High calcium
Abnoomally high phospate (poor excretion renal failure)
Low vit D
Abnormal renal function

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5
Q

What causes tertiary hyperparathyroidism

A

Consistent raised PTH from 2ndry, parathyroid gland hypertrohies - ignores negative feedback from calcium lvels

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6
Q

What is hypercalcemia defined as

A

Serum calcium level >2.6 mmol/L

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7
Q

High calcium symptoms

A

Nomrally asymptomatic
May be unusually thirsty
urinate frequently
Become constipated

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8
Q

indications for measuring serum calcium

A

Symptoms of hypercalcemia
Osteoporosis or previous fragility fracture
Renal stone
Incidental finding of >2.6 calcium
Chronic non differentiated symptoms

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9
Q

Indications fro measuring PTH level

A

Calcium is >2.6 on at least 2 separate occasions OR
>2,.5 mmol/L on 2 separate occasions and primary hyperPTHism suspected

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10
Q

When refer for primary hyperparathyroidism

A

above the midpoint of the reference range and primary hyperparathyroidism is suspected or

below the midpoint of the reference range with a concurrent albumin-adjusted serum calcium level of 2.6 mmol/litre or above.

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11
Q

How to differentiate hyperparathyroidism primary vs familial hypocaliuric hypercalcemia

A

Urine calcium excretion with:
24-hour urinary calcium excretion

random renal calcium:creatinine excretion ratio

random calcium:creatinine clearance ratio.

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12
Q

What assess in people with confirmed primaray hyperPTHism

A

Symptoms and comorbidities
Measure eGFR or creatinein
DEXA of lumbar spine and hip
US of renal tract
Measure vit D

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13
Q

How is referred for parathyroid surgery with primary hyperparathyrodisim?

A

Sympotms of hypercalcemia
End organ disease
Calcium >2.85

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14
Q

Surgeries for hyperparathyrodisim

A

4 gland exploration
Focused parathyrodiectomy

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15
Q

Post surgery management of primary hyperparathyrodisim

A

Measure calcium 3-6 months after to confirm sucess
Monitor once a year if successul

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16
Q

Non surgical managemnet of orimary hyperparathyroidism

A

Cincacalcet - calcimimetic
Nisphophonates

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17
Q

What calcium levels can offer cinacalcet

A

> 2.85 w symptoms
3.0 with or without symptoms

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18
Q

Who consider bisphosphonates in

A

Reduce fracture risk if increased risk
DONT offer if chronic ypercalcemia from primary hyperparathyrodisim

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19
Q

What risk need to assess with hyperPTH ism

A

Cardiovascular
Osteoporosis - fracture risk

20
Q

Hyperparathyroidism in pregnancy what stop, what increased risk of

A

Cinacalcet, bisphosphonates
More risk of hypertensive disease

21
Q

Cuases of primary hyperparathyrodisim

A

85%: solitary adenoma
10%: hyperplasia
4%: multiple adenoma
1%: carcinoma

22
Q

How to remember hyperPTH symptoms

A

Bones, stones, abdo graons, pscyhic mones

23
Q

Possible presentations with hyperparathyroidism

A

Polydipsia, polyuria
Depression
Anorexia, nausea, constipation
Peptic ulcers
Pancreatitis
Bone pain/fracture
Renal stones
HPTN

24
Q

What can be ass with hyperPTHism

A

HPTN
Multiple endocrine neoplasia - MEN I + II

25
Q

X ray findings in hyperPTHism

A

Pepperpot skull
Osteitis fibrosa cystica

26
Q

Definitive management of hyperPTH ism

A

total parathyroidectomy

27
Q

When can conservative management be offered

A

Ca less than 0.25 above upper limit of normal AND
>50 years and no evidence end organ damage

28
Q

What is parathyroid hormone produced in response to

A

LOW calcium and HIGH phosphate in blood

29
Q

Role of PTH

A

stimulates osteocasts to increase Ca release
Acitvates vit D in kidneys -> increase absorption of Ca and phosphate

30
Q

What inhibits PTH release

A

High calcium
Activated vit D

31
Q

Bloods in hyperPTH

A

High calcium
High PTH
Hypoposphatemia (lost in urine)

32
Q

Treating secondary hyperPTHism

A

Low phosphate diet
Ergocalciferol - low Vit D
Phosphate binders eg senglomer
Treat CKD

33
Q

Bloods in secondary hyperPTHism

A

HIGH PTH
normal/low calcium
HIGH phosphate

34
Q

When does 2ndry -> tertiary hyperparathyroidims and mangaenet

A

When calcium goes high and PTH is extremely high
Treat the same as primary hyperPTHism

35
Q

INherited causes of hyperparathyroidsim

A

MEN
Jaw tumour syndromme
Familial isolated rimary hyperPTH

36
Q

Risk for primary hyperPTH

A

Women
Older
FH - multi-gland, MEN

37
Q

Primary hyperparathyroidism comlications

A

Osteoporosis and fragility fractures
Kidney stones and kidney injury
Hypertension and heart disease
Numerous gastrointestinal disorders including peptic ulcer disease, pancreatitis and gall stones

38
Q

Parathyroidectomy comlpications

A

General for surgery
Recurrent or superior laryngeal nerve damage
Post op hypocalacemia if remove too mich
Failure to identify adenoma or disease peristency post surgery

39
Q

When is surgery indicated primary hyperarathyroidism

A

Symptomatic disease - hypercalcemia, osteoporosis+/- fragility fractues
Renal stone or nephrocaclinosis
Age <50
Serum calcium >2.85
eGFR <60

40
Q

Medical treatment of hypeparathyroidism

A

Calcitonin - reduces serum calciu
Cinacalcet - calcium muimetic
Desonumab - impairs resorbtion
Bisphosphonates

41
Q

What is PTH level if hypercalcemia of malignancy

A

Low

42
Q

Biochemistry primary vs seoncdary vs tertiary hyperparathyroidism

A

Primary - both PTH and Ca elevated
Secondary - PTH elecated calcium low or normal, vit D low
Tertiary - Calcium high or noraml, elevated PTH, elevated ALP, normal or decreased phosphate and calcium

43
Q

What causes secnodary hyperaparthyroidsim

A

Chronic renal disease due to low calcium -< hyperplasia PTH gland

44
Q

Surgery indications secondary yyperaparathyroidsim

A

Medication unless:
Bone pain
Persistent pruritis
Soft issue calcifications

45
Q

Management of tertiary hyperparathyroidism

A

Allow 12 months post transplant - may resolve
Total parathyroidectomy and reimplantation of part of gland
Unless gland causing identified then remove that

46
Q

Secondary hyperparathyorisim symptoms

A

-> bone disease, osteitis fibrosa cystica and soft tissue calcifications

47
Q
A

Endocrine (17 decks)

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