parathyroid Flashcards
What is the parathyroid gland
4 pea sized gland located on the posterior surface of the thyroid
What is the job of the parathyroid gland
parathyroid hormone (PTH) secretion for the regulation of serum calcium levels (direct correlation)
What are the severel targets PTH can act on to alter serum calcium levels
bones
kidneys
GI tract
What vitamin is necessary for calcium homeostasis and absorption
Vitamin D
Where is Vitamin D activated
kidneys, stimulated by PTH
What is the function of calcitonin
functions to lower serum calcium
Where is calcitonin secreted from
by the thyroid in response to elevated serum calcium
What is hyperparathyroidism
overactive parathyroid
*can be primary or secondary
What is primary hyperparathyroidism
problem is the parathyroid themselves
*generally from a parathyroid adenoma
What is secondary hyperparathyroidism
problem outside of the parathyroid
*hyperphosphatemia, renal failure, malabsorption of vitamin D
What is the most common cause of primary hyperparathyroidism
Hypercalcemia
What are the causes of primary hyperparathyroidism
1 single gland adenoma
hyperplasia
multiple adenoma
carcinoma
Which gender is at higher risk for hyperparathyroidism
women (60-70y/o)
*african american
IF symptoms present with primary hyperparathyroidism, what are they
Bones (joint pain)
stones (kidney stones)
abdominal groans (N/V)
psychic moans (depression)
fatigue overtones
If calcium >14 or PTH>5x normal, what should be considered
cancer
What is the first lab that should be drawn when working up hyperparathyroidism
serum calcium
How can you confirm hyperparathyroidism
urinary calcium
*genetic testing <40y/o
What is the mainstay treatment of hyperparathyroidism
parathyroidectomy
What is the surgical criteria for primary hyperparathyroidism
calcium >11.5
DXA <-2.5
+ kidney stones
+ hx fragility fx
age< 50
What is a concern for people post op with hyperparathyroidism
transient hypocalcemia
what is the only direct pharmacotherapeutic option for hypercalcemia
Cincalcet
What osteoporosis medications can be given with primary hyperparathyroidism
bisphosphonates
How do you treat secondary hyperparathyroidism
treat underlying cause
-increase calcium
-decrease phosphorus
-increase vitamin D
- HD if CKD present
What is the number one cause of hypoparathyroidism
parathyroid damage during surgery
What are some symptoms of hypoparathyroidism
paresthesias
tetany
seizures
arrhythmias
SOB/Stridor
What are characteristics of hypoparathyroidism seen on PE
Chovsteks sign
Trousseaus sign
hyperreflexia
What is chovsteks sign
tap on facial nerve = ipsilateral grimace
What is trousseaus sign
involuntary movement of wrist/hand with BP cuff inflation
What are those with hypoparathyroidism at an increased risk for
cataracts
What is the mainstay treatment for hypoparathyroidism
calcium + activated Vitamin D supp
