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T2 Endo/Repro > MOD 7 > Flashcards

MOD 7 Flashcards

1
Q

Which receptors sense ca levels to produce pth?

A

If low Ca, CaSR receptors in PT gland sense this and act on various parts of body to increase Ca

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2
Q

Effects of PTH on body

A

Directly: PTH incr Ca reabs in DCT and decr PO4 reabs in PCT, and stim 1a-hydroxylase which converts 25 to 1,25 active vit D (which induces osteoblast then osteoclast act in BONE, and enhances Ca abs via GUT)

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3
Q

What does PTHrP (PTH related protein) do?

When is it clinically relevant?

A

simialr stuff to PTH
-binds to pthrp R in BONE incr osteoblast/clast causing hypercalc, and in kidney tubule

  • can be stimulated to be produced by the growth factotrs made by tumor cells such as TGF-B
  • examine if sus hypercalc of malig (most common is SCC!)
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4
Q

Possible causes of hypercalc?

A

Endocrine disorders (MOST COMMON) in PTH prod
Malig (elev PTHrP or other factors)
Inflam disorders (eg sarcoidosis)
HIV illness
Drugs (thiazides and lithium, vitamins and sxe)

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5
Q

Hypercalcemia caused by inflam disorders?

A

EG granulomatous disease can cause hypercal such as SARCOIDOSIS (common in NOLA), where a1-OH overexpressed in macros causing incr in vit D (so lots of pts with sacroidosis have hypercalc)

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6
Q

Hypercalc caused by HIV?

A

takes more Ca for CaSR to sense, and then suppress PTH

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7
Q

Hypercalc caused by drugs?

A

Thiazides- incr Ca in PCT causing modest Hypercalc, may look like hyperPTism
Lithium: incr CaSR set point (takes more Ca to be sensed to suppress PTH) causes secondary hyperPTism (persists)–tx is bisphophonates to protect from osteoporosis

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8
Q

What is hyperparathyroidism usu from in most patients, and what are some dx levels?

A

PT gland tumor!

  • pts on routine blood test will have incr Ca in urine (too much cant all get abs by kidneys so spills into urine), renal stones (since more Ca)
  • elev Ca(blood/urine)/PTH/low PO4, and hgih alkaline phosphatase which is a marker for BONE TURNOVER
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9
Q

What does superiosteal (eg phalanges) bone resorption indicate?

A

Hyperparathyroidism!

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10
Q

Sx and assoc issues in hyperPTism?

A

wrist and hip bone loss (and vert), superiosteal (phalanges etc) bone resorp
-stuff like PUD and GI stuff, OSTEO FIBROTIC CYSTICA (if severe, cystic bones paces fill with brown fibrous “tumor” material whic is really osteoclasts and deposited hemosiderin from hemm causing bone pain)

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11
Q

Tx for hyperPTism

A

surgery to remove PT gland, usu cured, can restore bone loss by giving Ca (bone hungry)

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12
Q

Other causes of hyperparathyroidism

A

Familial primary HPTism -MEN

and Familial Hypocalciuric hypercalcemia

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13
Q

Familial primary hyperPTism

MEN-1

A

This is MEN (Multiple Endocrine Neoplasia) (AD)
MEN 1- mutation in tsg MEN1 (which would noramlly encode menin) causing pit tumors (like prolactinoma), pancreatic endocrine tumors (ZE, vipoma, glucagonoma), or PT adenoma

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14
Q

MEN-2A

A

activation of RET protooncogene which can cause pt hyperplasia, MEDULLARY THYROID CANCER (presents with amyloid in stroma), bilateral pheochromocytoma)

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15
Q

Familial Hypocalciuric Hypercalcemia

A

AD due to loss of function of CASR gene mutation so Ca not sensed (like w lithium pts), so PTH not suppressed, need to screen for this before removing PT gland (dont do surgery if they have it)
-there will be LOW ca in the URINE! bc extra renal uptake by kidneys (unlike pirmary hyperPTism where it would be high)

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16
Q

Malignancy Associated Hypercalcemia

A

usu with cancer
Ca usu hyper than in hyperPTism
High Ca so suppreses PTH levels, but PTHrP levels elev bc tumor (eg squamous and MANY other tumors in all systems have this)

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17
Q

Tx for malig assoc hypercalc

A

Hydrate and give loop diuretics and NaCl like Lasix to cause Ca diuresis, calcitonin short term, and bisphosphonates long term control, gluco corticoids, denosumab if they have kidney disease (anti resorpbtive, works as well as bisphosphonates)

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18
Q

Sarcoidosis induced hypercalcemia

A

v common in NOLA, most hypercalcURIC some hypercalcEMIC

  • ELEV VIT D DUE TO EXTRA ENZ prod by macros in sarcoid granuloma
  • can suppress by steroids nad chloroquine
  • hypercalc can also occur from TB, histo, coccidiomycosis in southwest, bartonella
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19
Q

What is sestamibi scan for

A

Dx for tumor of parathyroid gland!
give them this which is a radiolabeled tech99, taken up by PTH gland. if it disappears quickly its normal if it stays theres a tumor

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20
Q

common PT adenoma sx (hyperPTH)

A

fractures esp in hip spine wrists / cortical areas

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21
Q

what cancer can rel PTHrP

A

SCC (saline and calcitonin can tx, and surg)

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22
Q

SPEP is for dx of

A

multiple myeloma

23
Q

What do sx of High vitamin D and High Ca2?

A

Possibly Sarcoidosis which incr vit D thus incr Ca2 which decr PTH, tx with CHloroquine

24
Q

What must you always do when looking at Pt Ca level?

A

correct it for albumin! so if low alb<4, ADD to Ca level

25
Q 
What will Ca2+ levels, PTH levels, and general causes be in:
Primary hyperPTHism
SEcondary hyperPTHism
Malignancy
Inflamm
A

prim- High PTH causing high Ca from adenoma
Sec- ??? from RF
Malig- High Ca from PTHrP thus low PTH
Inflam- high Ca from VIt D but low PTH (eg sarcoid etc)

26
Q

What can cause HYPOcalcemia?

A

PT issues, or Vit D deficiency

27
Q

Vit D deficiency causes

A

nutritional, sunlight, malabs, gastric bypass, cirrhosis, CKD, rickets

28
Q

PT issues that can cause hypocalc

A

hypo after surg, autoimm, gen
pseudohypo, removal of PT causing hungry bone syndrome, drugs like bisphoshpoantes IV or denosumab
sclerotic mestastases etc

29
Q

what does Ca/PO4, 24h urine ca, alk phos, and pth look like in vitamin D def labs>

A

low Ca and/or PO4
low urine Ca
elev alk phos and PTH

30
Q

Radiographic findings in hypOcalc

A

skeletal pseudo fracture (break that doesn go thru entire thickness of bone)

31
Q

Vit D def tx

A
  • ergocalciferol, vit D
  • creon suppl in pacnreatic insuff
  • tube feeding with cholecalciferol
32
Q

Rickets

A

can cause VITAMIN D DEF

  • bone pain, delayed growth, fracture and BOWING OF LEGS due to weak bones, hypotonia, cavities, not enough sunlight
  • Type I is defect in 1a enz, low 1,25, tx with Ca and calcitriol
  • Type II is defect in vit D rec binding of 1,25, 1,25 lvls high, tx with ergocalc, cholecal or calcitriol, Ca and PO
33
Q

Pseudohypoparathyroidism

A

RESISTANCe to PTH (body isnt responding), so hypocalc, hyperphos, elev PTH (more in females), 3 types 1a 1b 2

34
Q

1a pseudo

A

Albright’s hereditary osteodystrophy
AD, renal res to PTH, also to TSH gonadotropin and GHRH
-sx: short 4th metacarpal, knuckle dimples
-gene mut GNAS on 20q13 (GNAS is noramlly where PTH binds)

35
Q

1b pseudo

A

renal res to PTH again, many have TSH, no 1a phenotypic changes but DELAYED ERUPTION OF TEETH AND HYPOPLASIA OF DENTAL ENAMAL, also gnas assoc

36
Q

psuedo 2

A

TISSUES res to PTH, no skeletal or phenotypic changes

37
Q

Pseudo-psuedohypoparathyroidism

A

Phenotypic change of psuedohypoparathyroidism, but NO actual renal or skel resistance to pth!

38
Q

Most common cause of hypocalc?

A

Vit D Def

39
Q

Dif between psuedo and psuedopsuedo hypoparathyroidism

A

psuedo have RES to PTH whereas pseudopsuedo dont

40
Q

Common reasons for secondary osteo?

A

VIT D DEF
hypercalciuria
malabs
hypogonadism in men

41
Q

Osteomalacia sx>

A

muscle weakness and bone pain esp hips, softening of bones caused by impaired bone met
-inadeuqate levls of avail phos, ca or vit D, INADEQUATE BONE MINERALIZATION (RICKETS in kids), has bowing of the legs

42
Q

What will be positive in Celiacs pt when they eat gluten?

A

tTG-IgA
IgA (anti endomysial antibody and abs against tissue translutaminase) both
can cause anemia due to malabs and low albumin, low vit D causing elev PTH sx

43
Q

DXA scan

A

tests bone density, if negative may mean (-2.5 or less without fracture) osteoporosis (or could be celiacs with elev PTH from lack of vit D abs) which can cause osteomalacia (both cause low bone density)

44
Q

What bone dis can severe prolonged Vit D def cause?

A

Osteomalacia

45
Q

What do bisphosphonates do>

A

Tx for osteoporosis to decr bone RESORBP

46
Q

Dx of osteomalacia

A

biopsy of bone! rare so need hx (eg why isnt pt getting enough nutrients, is it celiacs or lack of vit d, nursing home etc)

47
Q

What coudl cause high PTH with hgih Ca?

How would you dx?

A

Hyperparathyroidism (primary or tertiary, secondary may not cause high Ca and may be kidney issue)
Familial hypocalciuric hypercalcemia (but would be low in urine)
Dx with sestamibi scan (cpd abs by overactive PTH gland)

48
Q

HyperpTH sx?

A

Stones, Bones, Groans etc

49
Q

FHH (familial hypOcalciuric hypercalcemia)

A

looks similar to hyperPTH, due to inactivating mutations in CASR gene, kidneys taking up more Ca
-phenotype normal but hallmark is LOW URINE CA EXXCRETION and bone density may be normal, AD

50
Q

What might high ALP (hyperphosphatasia?) indicate

A

Pagets disease of the bone

51
Q

What might low ALP (Hypophosphatasia) cause (sx)

A

teeth fall out, fractures,

52
Q

What is GGT test for?

A

blood test to det cause of elev ALP

If bone disease, ONLY ALP will be elev! not ggt, otherwise if it is itll be liver dis or smth

53
Q

Paget’s disease of the bone
sx
appearnce on CT
pop

A

Osteoitis deformans–localized disorder of bone remodling, excessive boen resrption then formation of new woven bone which is more sus to fracture

  • sx: bone pain, joint pain etc, bowing, excessive warmth due to hypervasc, neurologic, common remodeling dis after osteoporosis, more common in older white males,
  • Cotton wool appearance on CT
54
Q

Paget’s disease of the bone mutation

A

SQSTM1 gene mut (KNOW!)

T2 Endo/Repro (11 decks)

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