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Endocrine > Parathyroid > Flashcards

Parathyroid Flashcards

1
Q

The parathyroids are two pairs of small, oval shaped glands on the _

A

The parathyroids are two pairs of small, oval shaped glands on the posterior thyroid

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2
Q

The superior parathyroids are derived from the _

A

The superior parathyroids are derived from the fourth pharyngeal pouch

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3
Q

The inferior parathyroids are derived from the _

A

The inferior parathyroids are derived from the third pharyngeal pouch

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4
Q

The consequences of hypercalcemia include _

A

The consequences of hypercalcemia include stones, bones, thrones, and psychiatric overtones
* Calcium oxalate stones
* Constipation
* Bone pain
* Psychosis
* Arrhythmias

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5
Q

Consequences of hypocalcemia

A

Consequences of hypocalcemia:
* Tetany
* Prolonged QT interval
* Seizures

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6
Q

Chvostek sign is indicative of _

A

Chvostek sign is indicative of hypocalcemia

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7
Q

Trousseau’s sign is indicative of _

A

Trousseau’s sign is indicative of hypocalcemia

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8
Q

QT prolongation is a sign of _ calcemia

A

QT prolongation is a sign of hypocalcemia

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9
Q

PTH is a _ type of hormone

A

PTH is a peptide hormone

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10
Q

PTH is made by _ cells

A

PTH is made by chief cells

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11
Q

PTH acts on the bones to increase the release of _ and _

A

PTH acts on the bones to increase the release of calcium and phosphorus

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12
Q

PTH increases the activity of _ type cells which then activate _

A

PTH increases the activity of osteoblasts which then activate osteoclasts

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13
Q

PTH has three important effects on the kidney, _ , _ , _

A

PTH has three important effects on the kidney, increase Ca2+ absorption , increase phosphate excretion , increase 1alpha-hydroxylase activity

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14
Q

1a-hydroxylase forms _

A

1a-hydroxylase forms 1,25-dihydroxyvitamin D (aka calcitriol)

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15
Q

Calcitriol is _

A

Calcitriol is activated vitamin D also known as:
* 1,25-Dihydroxyvitamin D
* D3

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16
Q

Increased calcitriol will have _ and _ effects on the GI system

A

Increased calcitriol will cause increased Ca2+ absorption and increased PO3- absorption in the gut

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17
Q

Calcitriol is made in the _

A

Calcitriol is made in the proximal tubular cells of the kidney

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18
Q

Although, the effect of 1,25(OH)2D is to (increase/decrease) phosphorous at the bone and gut, the net effect of the kidney is _

A

Although, the effect of 1,25(OH)2D is to increase phosphorous at the bone and gut, the net effect of the kidney is phosphorous excretion (net decrease)

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19
Q

Fibroblast growth factor 23 (FGF23) is mostly concerned with _ homeostasis

A

Fibroblast growth factor 23 (FGF23) is mostly concerned with phosphorus homeostasis

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20
Q

FGF23 is secreted by _ cells

A

FGF23 is secreted by osteocytes and osteoblasts

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21
Q

What is the effect of elevated FGF23?

A

High FGF23 –>
* Decreases calcitriol
* Increases PO4 excretion
* Decreases PTH

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22
Q

Calcitonin is secreted by _

A

Calcitonin is secreted by parafollicular C cells

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23
Q

What is the function of calcitonin?

A

Calcitonin opposes PTH –> decreases osteoclast activity and decreases renal Ca2+ resorption

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24
Q

PTH directly stimulates (osteoblasts/osteoclasts)

A

PTH directly stimulates osteoblasts –> make RANK ligand –> binds receptors on osteoclasts –> osteoclasts are activated

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25
Q

Name four causes of vitamin D deficiency

A

Name four causes of vitamin D deficiency:
1. Poor dietary intake
2. Decreased sun exposure
3. Malabsorption (IBD, gastric bypass)
4. Fat-soluble vitamin deficiency (celiac, CF)

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26
Q

_ is caused by vitamin D deficiency in children

A

Rickets is caused by vitamin D deficiency in children

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27
Q

_ is caused by vitamin D deficiency in adults

A

Osteomalacia is caused by vitamin D deficiency in adults

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28
Q

A deficiency in vitamin D causes PTH to (increase/decrease)

A

A deficiency in vitamin D causes PTH to increase

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29
Q

Rickets involves _ at the epiphyseal growth plates as a result of deficient vitamin D

A

Rickets involves defective cartilage mineralization at the epiphyseal growth plates as a result of deficient vitamin D

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30
Q

_ is a disorder of “bone softening” in adults whereby osteoid mineralization is abnormal from deficient vitamin D

A

Osteomalacia is a disorder of “bone softening” in adults whereby osteoid mineralization is abnormal from deficient vitamin D

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31
Q

What are the consequences of rickets/ vitamin D deficiency in children?

A

Consequences of rickets include:
* Bowed legs
* Kyphosis
* Scoliosis
* Fractures
* Poor growth
* Bone tenderness to palpation

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32
Q

Vitamin D deficiency (rickets or osteomalacia) is diagnosed via:
_ 1,25(OH)2D
_ PTH
_ alkaline phosphatase
_ Calcium
_ Phosphate

A

Vitamin D deficiency (rickets or osteomalacia) is diagnosed via:
Low 1,25(OH)2D
High PTH
High alkaline phosphatase
Low-Normal Calcium
Low-Normal Phosphate

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33
Q

Causes of hypoparathyroidism:

A

Causes of hypoparathyroidism:
* Surgical damage
* Damage to blood supply
* DiGeorge
* Autoimmune destruction
* Hypomagnesemia

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34
Q

Causes of hyperparathyroidism:

A

Causes of hyperparathyroidism:
* Parathyroid adenoma
* Hyperplasia

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35
Q

The downstream effect of hypoparthyroidism will be a dysregulation of calcium and phosphate levels resulting in (high/low) calcium and (high/low) phosphate

A

The downstream effect of hypoparthyroidism will be a dysregulation of calcium and phosphate levels resulting in low calcium and high phosphate

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36
Q

The clinical presentation of hypoparathyroidism may include _

A

The clinical presentation of hypoparathyroidism may include Chvostek sign, Trousseau sign, hyperphosphatemia, tetany
* Signs of low calcium and high phosphate

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37
Q

Management for hypoparathyroidism includes _

A

Management for hypoparathyroidism includes oral calcium, vitamin D, magnesium, thiazides, PTH replacement

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38
Q

_ is a decreased end organ sensitivity of PTH

A

Pseudohypoparathyroidism is a decreased end organ sensitivity of PTH
* It is a “pseudo” hypoparathyroidism because PTH will actually be high, sensitivity is just low

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39
Q

Pseudohypoparathyrodism is caused by an (AD/AR) mutation in the _ gene that leads to decreased end organ sensitivity to PTH

A

Pseudohypoparathyrodism is caused by an autosomal dominant mutation in the GNAS1 gene that leads to decreased end organ sensitivity to PTH

40
Q

GNAS1 is a gene that encodes a _ G protein subunit

A

GNAS1 is a gene that encodes a Gs alpha subunit

41
Q

Pseudohypoparathyrodism will involve:
_ calcium
_ phosphate
_ PTH

A

Pseudohypoparathyrodism will involve:
low calcium
high phosphate
high PTH

42
Q

Hyperparathyroidism will cause _ calcium and _ phosphate levels

A

Hyperparathyroidism will cause high calcium and low phosphate levels

43
Q

Bone pain and bone fractures are associated with (hypo/hyper) parathyroidism

A

Bone pain and bone fractures are associated with hyperparathyroidism

44
Q

High alkaline phosphatase (ALT) may be indicative of (hypo/hyper) parathyroidism

A

High alkaline phosphatase (ALT) may be indicative of hyperparathyroidism

45
Q

We can treat hyperparathyroidism with calcimimetics like _ , bisphosphonates such as _ , or parathyroidectomy

A

We can treat hyperparathyroidism with calcimimetics like cinacalcet , bisphosphonates such as alendronate , or parathyroidectomy

46
Q

Secondary hyperparathyroidism (hyperplasia of the glands) can be caused by _ or _

A

Secondary hyperparathyroidism (hyperplasia of the glands) can be caused by decreased phosphate excretion or decreased vitamin D
* These things signal that the PTH aren’t working properly and we should proliferate

47
Q

_ is a very common cause of secondary hyperparathyroidism due to the impaired 1alpha-hydroxylase activity and increased phosphate retention

A

Chronic kidney disease (CKD) is a very common cause of secondary hyperparathyroidism due to the impaired 1alpha-hydroxylase activity and increased phosphate retention

48
Q

Why does PTH fail to correct hypocalcemia in the case of secondary hyperparathyroidism from CKD?

A

PTH fails to correct hypocalcemia because in CKD we have diminished 1a-hydroxylase activity and the retained phosphate will bind up the calcium

49
Q

Secondary hyperparathyroidism (CKD) is associated with
_ calcium
_ phoshate
_ PTH
_ ALT

A

Secondary hyperparathyroidism (CKD) is associated with
Low calcium
High phoshate
High PTH
High ALT

50
Q

Management options for secondary hyperparathyroidism (due to CKD):

A

Management options for secondary hyperparathyroidism (due to CKD):
* Phosphate binder (Sevelamer)
* Calcimimetics (Cinacalcet)
* Bisphosphonates (Alendronate)
* Calcitriol
* Parathyroidectomy

51
Q

_ is a phosphate binder that can be used for secondary hyperPTH

A

Sevelamer is a phosphate binder that can be used for secondary hyperPTH

52
Q

_ is a calcimimetic which is used in hyperparathyroidism treatment

A

Cinacalcet is a calcimimetic which is used in hyperparathyroidism treatment

53
Q

_ is a bisphosphonate drug used to treat hyperparathyroidism

A

Alendronate is a bisphosphonate drug used to treat hyperparathyroidism

54
Q

Tertiary hyperparathyroidism is most common in _

A

Tertiary hyperparathyroidism is most common in post-transplant CKD patients; it involves autonomous hyperparathyroidism
* Long periods of hyperphosphatemia in CKD lead to continued stimulation of PT –> desensitization –> autonomous activity

55
Q

Tertiary hyperparathyroidism presents with _ and should be treated via _

A

Tertiary hyperparathyroidism presents with high calcium, low phosphate, high PTH, sx of hypercalcemia and should be treated via parathyroidectomy

56
Q

_ is a condition that usually occurs from primary parathyroidism and involves “brown tumors” and bone pain due to increased osteoclast activity

A

Osteitis fibrosa cystica is a condition that usually occurs from primary parathyroidism and involves “brown tumors” and bone pain due to increased osteoclast activity

57
Q

Explain the pathogenesis of osteitis fibrosa cystica

A

Explain the pathogenesis of osteitis fibrosa cystica:
1. High PTH
2. Increased osteoclast activity
3. Cystic bone spaces –> hemosiderin deposition
4. Creates “brown tumor” and bone pain

58
Q

Pseudogout, pancreatitis, and polyuria may be clinical findings of (hyper/hypo) parathyroidism

A

Pseudogout, pancreatitis, and polyuria may be clinical findings of hyperparathyroidism

59
Q

_ is a bone disorder due to CKD; associated with secondary hyperparathyroidism; it involves decreased active vitamin D, increased phosphate, increasted PTH, increased bone turnover and weak bones

A

Renal osteodystrophy is a bone disorder due to CKD; associated with secondary hyperparathyroidism; it involves decreased active vitamin D, increased phosphate, increasted PTH, increased bone turnover and weak bones

60
Q

_ is an inherited mutation in the calcium sensing receptor gene that requires additional calcium to suppress PTH

A

Familial hypocalciuric hypercalcemia is an inherited mutation in the calcium sensing receptor gene that requires additional calcium to suppress PTH

61
Q

FHH is an autosomal dominant mutation in the _ gene

A

FHH is an autosomal dominant mutation in the CaSR gene

62
Q

FHH involves defective G-coupled calcium receptors in the _ and _

A

FHH involves defective G-coupled calcium receptors in the kidney and parathyroids
* Higher amounts of calcium needed to suppress PTH

63
Q

What diagnostics are needed to diagnose FHH?

A

FHH will show
* High PTH
* High Ca2+
* Low 24 hour urine Ca2+

64
Q

Only about _ % of calcium is circulating in the blood

A

Only about 1% of calcium is circulating in the blood
* About 99% is stored in the bones

65
Q

The majority of elemental calcium and phosphorus in the human body are found in the _

A

The majority of elemental calcium and phosphorus in the human body are found in the bones

66
Q

About _ % of serum calcium is biologically active

A

About 50% of serum calcium is biologically active
* Of the calcium that is in the blood, only 50% is free or ionized

67
Q

The parathyroid glands have _ which help in the regulation of PTH release

A

The parathyroid glands have calcium sensing receptors which help in the regulation of PTH release

68
Q

What is the action of PTH on the kidneys?

A
  1. Increased phosphate secretion
  2. Increased calcium reabsorption
  3. Increased active vitamin D
69
Q

What is the action of PTH on the bone?

A

PTH activates osteoblasts –> osteoclasts; we ge an increase in calcium and phosphorus release

70
Q

What is the effect of PTH on the small intestine?

A

PTH increases calcium reabsorption via the effects of calcitriol

71
Q

_ mediates the increase in small intestine’s absorption of calcium and phosphate

A

Calcitriol mediates the increase in small intestine’s absorption of calcium and phosphate

72
Q

Calcitonin _ calcium

A

Calcitonin decreases calcium

73
Q

Hyperalbuminemia _ total calcium

A

Hyperalbuminemia increases total calcium

74
Q

Hypoalbuminemia _ total calcium

A

Hypoalbuminemia decreases total calcium

75
Q

Equation for corrected serum calcium

A

Corrected calcium = 0.8 (normal albumin - measured albumin) + serum calcium
* We usually use 4 g/dL for normal

76
Q

(Acidemia/Alkalemia) increases the ionized calcium level

A

Acidemia increases the ionized calcium level

77
Q

Labs expected with primary hyperparathyroidism

A

Labs expected with primary hyperparathyroidism:
PTH high
Calcium high
Phosphorus low
1,25D high

78
Q

Secondary hyperparathyroidism from CKD will have the following labs:
PTH
Calcium
Phosphorus
Creatinine
1,25D

A

Secondary hyperparathyroidism from CKD will have the following labs:
High PTH
Low Calcium
High Phosphorus
High Creatinine
Low 1,25D

79
Q

Secondary hyperparathyroidism from vitamin D deficiency will have the following labs:
PTH
Calcium
Phosphorus
Creatinine
1,25D

A

Secondary hyperparathyroidism from vitamin D deficiency will have the following labs:
PTH- high
Calcium- low
Phosphorus- low
Creatinine- normal
1,25D- low

80
Q

Tertiary hyperparathyroidism will have the following labs:
PTH
Calcium
Phosphorus
Creatinine
1,25D

A

Tertiary hyperparathyroidism will have the following labs:
PTH- high
Calcium- high
Phosphorus- high
Creatinine- high
1,25D- low

**This happens when the calcium sensing receptors on parathyroid have a new set point

81
Q

Causes of hypocalcemia

A

Causes of hypocalcemia:
* Hypoparathyroidism
* CKD
* Vitamin D deficiency
* Low magnesium
* Malabsorption
* Blood transfusion
* Pancreatitis
* Medications (loops, bisphosphonates)

82
Q

Causes of hyperparathyroidism

A

Causes of hyperparathyroidism:
* PTHrp from cancer
* Hyperparathyroidism
* Calcitriol secreting tumors
* Granulomatous disease
* Medications (thiazides)
* FHH

83
Q

Hypercalcemia is associated with _ QT interval

A

Hypercalcemia is associated with shortened QT interval
* Due to increased threshold potential

84
Q

PTHrp secreting malignancy labs:
Calcium
PTH
Phosphorus
Calcitriol

A

PTHrp secreting malignancy labs:
Calcium- high
PTH- low negative feedback from PTH
Phosphorus- low
Calcitriol- normal

85
Q

Granulomatous disease labs:
Calcium
PTH
Phosphorus
Calcitriol

A

Granulomatous disease labs:
Calcium- high
PTH- low
Phosphorus- high
Calcitriol- high

86
Q

Malignancy metastasized to bone labs:
Calcium
PTH
Phosphorus
Calcitriol

A

Malignancy metastasized to bone labs:
Calcium- high
PTH- decreased
Phosphorus- increased
Calcitriol- normal

87
Q

FHH labs:
Calcium
PTH
Phosphorus
Calcitriol

A

FHH labs:
Calcium- high
PTH- high
Phosphorus- low
Calcitriol- high

88
Q

Sx of hypercalcemia

89
Q

Osteoporosis, brown tumors, and nephrolithiasis are all complications of _

A

Osteoporosis, brown tumors, and nephrolithiasis are all complications of primary hyperparathyroidism

90
Q

The two treatment options for primary hyperPTH are _ and _

A

The two treatment options for primary hyperPTH are surgery and cinacalcet
* Can treat hypercalcemia with IV fluids, bisphosphonates, calcitonin, loops

91
Q
A

Brown tumor- primary hyperparathyroidism

92
Q

Parasthesias, muscle twitching, and hyperreflexia are associated with (hypercalcemia/hypocalcemia)

A

Parasthesias, muscle twitching, and hyperreflexia are associated with hypocalcemia

93
Q

Two important PE findings associated with hypocalcemia are _ and _

A

Two important PE findings associated with hypocalcemia are Chvostek’s sign and Trousseau’s sign

94
Q

Two important arrythmias associated with hypocalcemia are _ and _

A

Two important arrythmias associated with hypocalcemia are prolonged QT and Torsades

95
Q

Three causes of hypoparathyroidism in adults

A

Three causes of hypoparathyroidism in adults
1. Thyroidectomy
2. Autoimmune
3. Hypomagnesemia

96
Q

The major problem in pseudohypoparathyroidism is _

A

The major problem in pseudohypoparathyroidism is PTH resistance

97
Q

We treat pseudohypoparathyroidism with _ and _

A

We treat pseudohypoparathyroidism with calcitriol and ca2+ supplementation or with synthetic PTH

Endocrine (8 decks)

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