Parathyroid Flashcards

1
Q

What is the function if PTH ?

A

🔺free Ca in the blood
- 🔝Ca & PO4 absorption in GIT
- 🔝 Ca & PO4 from bone resorption
- 🔝 Ca reabsorption from DCT
- ⬇️ PO4 reabsorption in PCT
🟢 activate 1a-hydroxylase » 🔝 calcitriol

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2
Q

PTH:
[…] serum Ca
[…] serum PO4
[…] urine PO4
[…] urine cAMP

A

🔺 serum Ca
🔻 serum PO4
🔺 urine PO4
🔺 urine cAMP

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3
Q

How serum ions affects regulation of PTH secretion?

A

🔻 serum Ca » 🔝 PTH secretion
🔺 serum PO4 » 🔝 PTH secretion
🔻 serum Mg » 🔝 PTH secretion
🔻🔻 serum Mg » ⬇️ PTH secretion

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4
Q

Changes in blood […] alter PTH by affecting ionizing Ca concentration

A

pH
🔺 pH: albumin bind ionized Ca 🔺PTH
🔻pH:🔻 PTH

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5
Q

1° hypoparathyroidism
[…] PTH […] Ca […] PO4

A

🔻 PTH 🔻 Ca 🔺 PO4
#surgical resection
#autoimmune / Di-George

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6
Q

PTH-independent hypercalcemia
[…] PTH […] Ca […] PO4

A

🔻 PTH 🔺 Ca 🔻 PO4
#malignancy
# 🔝Ca intake
# 🔝 Vitamin D

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7
Q

1° hyperparathyroidism
[…] PTH […] Ca […] PO4

A

🔺 PTH 🔺 Ca 🔻 PO4
#adenoma (80%)
#hyperplasia (15%)
#carcinoma

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8
Q

2° hyperparathyroidism
[…] PTH […] Ca […] PO4

A

🔺 PTH 🔻 Ca 🔺 PO4
#CKD
#VitD deficiency

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9
Q

3° hyperparathyroidism
[…] PTH […] Ca […] PO4

A

🔺 PTH 🔺 Ca 🔻 PO4
#autonomous (refractory) sHPT due CKD

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10
Q

Hypoparathyroidism manifestations:

A
  • Neuromuscular (tetany, paresthesia, seizure, 🔝DTR)
  • Cataract
  • Arrhythmia
  • Osteomalacia
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11
Q

Carpal spasm with occlusion of brachial artery with BP cuff

A

Trousseau sign
HypoCalcemia

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12
Q

Contraction of facial muscles with tapping facial nerve

A

Chovstek sign
HypoCalcemia

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13
Q

What are the manifestations of HyperCalcemia ?

A

-Stones (renal stones)
-Thrones (polyuria)
-Groans (abdominal pain)
-Bones (bone pain)
-Psychiatric overtone (depression, anxiety, insomnia ..)

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14
Q

Most common cause of 1° hyperparathyroidism : […]

A

Adenoma

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15
Q

Primary Hyperparathyroidism may be associated with […] syndrome

A

MEN 1 or 2a

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16
Q

End organ resistance to PTH
Due to imprinted GNAS gene
PE: Albright hereditary osteodystrophy

A

Pseudohypoparathyroidism type 1A

17
Q

Defective G-coupled Ca-sensing receptors

A

Familial hypocalciuric hypercalcemia

18
Q

What is the effect of Cinacalcet

A

Senacalcet 🔻Ca
Sensitize Calcium-sensing receptor in parathyroid to Ca » ⬇️PTH

19
Q

What is the effect of Sevelamer

A

🔻PO4
Prevent phosphate absorption from GIT

20
Q

Indications of parathyroidectomy in 1° HPT

A
  1. 🔺HyperCa
  2. 🦴Skeletal indications
    • osteoporosis
    • Hx vertebral fracture
  3. 🧻Renal indications
    • eGFR <60
    • 24hr urine Ca >400
    • nephrolothiasis
  4. 👱🏻Age <50 yr
21
Q

What is the recommended age to start screening for osteoporosis ?

A

👵🏻 65
👴🏻 70