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Endo/Repro: Week 1 > Krafts: Parathyroid Pathology > Flashcards

Krafts: Parathyroid Pathology Flashcards

1
Q

Where do the upper parathyroids come from?

A

FOURTH pharyngeal pouch>

descend w/ the thyroid

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2
Q

Where do the lower parathyroids come from?

A

THIRD pharyngeal pouch>

descend w/ the thymus

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3
Q

The first groove/cleft forms the…

A

ear stuff

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4
Q

What cells are associated w/ the parathyroid gland?

A

chief cells

oxyphil cells

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5
Q

What does PTH do?

A

INCREASES serum Ca:

bone resorption 
renal reabsorption of calcium
renal excretion of phosphate 
renal conversion of vitamin D to its active form
gut absorption of calcium
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6
Q

What is the purpose of Vit D?

A

Stimulates gut to absorb calcium, phosphorus

Helps PTH to get calcium out of bone

Stimulates kidney to reabsorb calcium

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7
Q

Where do you metabolize vit D?

A

liver (25 hydroxylase)

kidney (a-1 hydroxuylase)–> active form

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8
Q

What controls PTH release?

A

FREE Ca

Decreased Ca> increased PTH synthesis/release

Increased Ca> decreased PTH synthesis/release

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9
Q

What causes hypercalcemia?

A
  1. Hyperparathyroidism
  2. Malignancy***–>impt to rule out if a pt comes in w/ hypercalcemia
    - Metastases
    - PTH-related protein
  3. Vitamin D overdose
  4. Thiazide diuretics
  5. Milk-alkali syndrome (drink a lot of milk and eat a lot of tums)
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10
Q

What is the MC cause of SYMPTOMATIC hypercalcemia?

A

malignancy

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11
Q

What is the MC cause of asymptomatic hypercalcemia?

A

Hyperparathyroidism

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12
Q

What is primary hyperparathyroidism?

A

hyperparathyroidism d/t a parathyroid problem

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13
Q

What causes primary hyperparathyroidism?

A

Parathyroid adenoma**MC
Parathyroid hyperplasia
Parathyroid carcinoma

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14
Q

What are signs of primary hyperparathyroidism?

A

Very common and often asymptomatic!

Stone: kidney stones, other stones

Bone: pain, brown tumors, worse

Groan: gastrointestinal problems

Moan: mental changes

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15
Q

What is the mechanism of primary hyperparathyroidism?

A

Increased PTH>
gut absorbs more Ca/bone gives up more Ca>
ELEVATED serum Ca

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16
Q

What lab findings are associated with primary hyperparathyroidism?

A

Increased PTH and serum Ca

Decreased phosphate (inverse of Ca)

17
Q

What does PTH affect bone?

A 
Osteoclast activation (chewed up)
Osteoblast activation (build up)
Brown tumors
Osteitis fibrosa cystica (severe case of brown tumors and hypercalcemia)
18
Q

What are RANKL and M-DSF?

A

RANKL (ligand on osteoblast)>
RANK receptor on osteoclast precursor>
stimulates osteoclast to chew up bone

(same thing with M-CSF:M-CSFr)

19
Q

What is the MC cause of primary hyperparthyroidism?

A

Parathyroid adenoma

SOLITARY

20
Q

What genetic defects are associated w/ PT Adenoma?

A

PRAD 1 overexpression

MEN 1 loss or mutation (multiple endocrine neoplasia syndrome)

21
Q

What is PT hyperplasia?

A

less common
usually affects all 4 glands
most sporadic

22
Q

What is a rare cause of primary hyper PT?

A

parathyroid carcinoma

Sxs: abrupt onset of bone pain, usually well differentiated tumor w/ a POOR prognosis

23
Q

What is secondary HPT?

A

hyperparathyroidism d/t chronic hypocalcemia

24
Q

What causes secondary HPT?

A 
Renal failure (most cases)**
Diet poor in calcium
Vitamin D deficiency
25
Q

How does renal failure lead to HPT?

A

Can’t excrete phosphate>
Serum phosphate goes up/
Serum calcium goes down>
Hypocalcemia stimulates parathyroids

26
Q

What is tertiary HPT?

A

Occurs (rarely) in secondary hyperparathyroidism

Parathyroids are autonomously hyper-functional

27
Q

What causes hypoparathyroidism?

A 
Iatrogenic
Hereditary
DiGeorge syndrome
Agenesis (X-linked)
Idiopathic atrophy
28
Q 
Neuromuscular irritability
-Perioral numbness (tingly lips)
-Muscle weakness, cramps, tetany
-Chvostek’s sign
-Trousseau’s sign
Heart arrhythmias
Dental abnormalities

are all associated with what disease?

A

Hypoparathyroidism

29
Q

What are the two signs associated with hypoparathyroidism?

A
  • Chvostek’s sign = stroke cheek, facial nerve is hyperreactive is Ca is low
  • Trousseau’s sign= slowly inflate BP cuff and pt’s hand cramps up

Endo/Repro: Week 1 (10 decks)

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