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pathology 2 > parathyroid > Flashcards

parathyroid Flashcards

1
Q

parathyroid pathology revolved around

A

calcium - hypercalaemia
may be a cause or effect of parathyroid disease
parathyroid disease is not the only cause of hypercalcaemia

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2
Q

normal parathyroid is made up of

A

thin capsule with islands of parathyroid cells with fat in-between

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3
Q

parathyroid glands are located

A

four of the at the periphery of the thyroid

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4
Q

cell types in they parathyroid

A 
chief cells 
with variants (oxyphil and water clear) due to accumulation of other material
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5
Q

parathyroid hormone is produced by

A

chief cells

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6
Q

parathyroid hormone is released in response to

A

low serum calcium - free ionised calcium.

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7
Q

actions of parathyroid hormones

A
  • bone resorption
  • renal tubular resorption of calcium
  • increases conversion of vit D to active (hydroxy) form in the kidney
  • with vitamin D, promotes calcium resorption from small intestine
  • increases urnary phosphate excretion causing phosphaturia
  • net effect is to increase serum calcium
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8
Q

net effect of PTH

A

increase serum calcium

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9
Q

hypocalcaemia

A

usually due to accidental damage/removal of parathyroids during thyroid surgery

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10
Q

hypocalcaemia is usually due to

A

chronic renal failure, vit D deficiency, drugs, or intestinal malabsorption of Ca

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11
Q

hypocalcaemia causes

A

neuromuscular irritability

calcium. blocks sodium channels, so lower calcium decreases depolarisation threshold

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12
Q

symptoms of hypocalcaemia

A

CATs go numb
- convulsons, arrythmas, tetany, numbness/paresthesia

acute - syncope, cardiac arrhythmia, laryngospasm

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13
Q

hypercalcaemia is caused by

A

accelerated bone resorption
excessive GI absorption
Decreased renal excretion of calcium

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14
Q

diseases causing hypercalcaemia

A
  • hyperparathyroidism
  • hypercalcaemia of malignancy
  • drugs, metabolic/genetic disorders, chronic granulomatous disease
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15
Q

how is hypercalcaemia caused from malignancy

A
  • bone osteolysis due to skeletal metastasis
  • metabolic effects of malignant tumours - cytokine mediated
  • PTHrP secretion from tumours
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16
Q

excessive parathyroid hormone

A

increased PTH from parathyroid or PTHrP (parathyroid related protein) causes bone resorption

17
Q

excessive parathyroid hormone may be caused by

A

hyperthyroidism due to parathyroid tumours

extolc secretion of pTHrP by some other tumours

18
Q

disrupted Ca/PO4 homeostasis

A

retention of phosphate inappropriately activates feedback loop leading to increased PTH secretion

19
Q

disrupted Ca/PO4 is caused by

A

renal failure

20
Q

excess vitamine D

A

excess vit D causes increases absorption (gut) respiration (kidney) and mobilisation (bone)

21
Q

excess vit D is caused by

A

vit D intoxication, sarcoidosis, idiopathic hypercalcaemia of infancy

22
Q

clinical manifestations of hypercalcaemia

A

stones, bones, abdominal groans and psychiatric moans

cardiovascular, ocular, dermatological

23
Q

primary hyperparathyroidism

A

excesss PTH production from the parathyroid
feedback indepedant production of PTH
one or more involved gland increasing in size while the others atrophy

24
Q

secondary hyperparathyroidism

A

other disease process drives increase in PTH production
abnormal homeostatic regulation but normal feedback mehcniasms
glands become hyper plastic

25
Q

tertiary hyperparathyroidism

A

autonomous PTH secretion, caused by long standing secondary HP
abnormal feedback mechanisms
usually due to long standing kidney disease
often autonomous nodule within hyper plastic glands

26
Q

ectopic secretion

A

parathyroid hormone related protein
paraneoplastic from other malignancies
feedback independent causing atrophy

27
Q

malignancy of parathyroid

A

rare

28
Q

parathyroid adenoma

A

benign neoplasm of parathyroid epithelium
most hyperparathyroid
usually solitary, occasionally multiple

29
Q

multiple parathyroid adenoma may indicate

A

MEN1

30
Q

parathyroid adenoma histological patterns

A 
sheets, acini, follicles, trabecular 
uniformity of cell type 
loss of reticulum;in framework 
no intraglandular fat 
rim of normal
31
Q

parathyroid hyperplasia

A

increased numbers of cells - polyclonal
typically involves all glands but may be asymmetrical
- usually <1g
mainly chief cells, may have mixed cell type, a nodular pattern
- usually sporadic, may be familial

32
Q

familial parathyroid hyperplasia

A
  • MEN1 - most patients
  • homozygous loss of suppressor gene on chromosome 11
  • less commonly MEN 2a

pathology 2 (47 decks)

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