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Endocrine > Parathyroid > Flashcards

Parathyroid Flashcards

1
Q

Which embryological tissue does the thyroid come from?

A

Endoderm

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2
Q

What are the 2 thyroid hormones from the folliclar (principle) cells?

A

T3 and T4

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3
Q

Which organelle is numerous in the follicular cells?

A

RER

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4
Q

What are the colloidal resorption droplets in the follicular cells of the thyroid?

A

lysosomes and endocytotic vesicels

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5
Q

What are the cells in the periphery of the follicular epithelim and secrete calcitonin?

A

Parafollicular (C) cells

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6
Q

What do u see in the C cells of the thyroid?

A

small secretory veiscles and a prominent golgi apparatus

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7
Q

Which branchial pouches are the parathyroid from?

A

3rd and 4th

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8
Q

Which embryological tissue does the parathyroid come from?

A

endoderm

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9
Q

What is the H that the principle cells secrete from the parathyroid?

A

PTH

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10
Q

What are the other parathyroid cells, which are larger than principle and are strongly acidophilic?

A

Oxyphil cells

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11
Q

What is the gross anatomy of the thyroid?

A

2 lateral lobes and an isthmus that connects the anterior surface

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12
Q

Which CN is closely realted to the thyroid?

A

recurrent laryngeeal nerves of X

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13
Q

What do the superior/inferior thyroid aa come from?

A

Superior thyroid - ECA

Inferior thyroid- from thyrocervical trunk

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14
Q

Which random a. is at risk for dmg in a tracheostomy?

A

Thyroid ima a.

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15
Q

Which pharyngeal pouches make the 2 upper and 2 lower parathryoid glands?

A

2 superior- 4th puch

2 inferior- 3rd pouch

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16
Q

What is the duct that is at the back of the tongue that is a remnant of the descent of the thyroid?

A

Thyroglossal duct

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17
Q

What is the result if the 2nd pharyngeal arch fails to grow over the 3rd and 4th arches?

A

Branchial fistula

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18
Q

What is the hump on the side of the neck called form a fistula?

A

Lateral cervical cyst

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19
Q

What is it called when there is an opening to the anterior neck from a fistula?

A

External branchial fistula

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20
Q

Where does the internal brancial fistula travel?

A

To the palatine tonsils

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21
Q

What is it called when there is persistant remnants of the pharyngeal cartilage or bony elements?

A

Branchial vestiges

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22
Q

Where is the typical location for brancial vestiges?

A

anterior to the inferior 1/3 of the SCM

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23
Q

What is it called when the thyroid doesnt descend correctly from the oral cavity to the neck?

A

Ectopic thyroid tissue

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24
Q

What might occur in the thyroglossal duct from the foramen cecum to the thyroid on the neck?

A

Cysts

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25
Q

What are the Sx of DiGeorge syndrome?

A 
Cleft palate
Abnormal facies
Thyroid atresia
Cardial abnormalities
Hypocalcemia
22q11 deletion

“CATCH 22”

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26
Q

What % of Ca in the body is ionized? bound? complexed to anions?

A

Ionized 50%
Bound 41%
Complexed 9%

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27
Q

What is the nromal rate of Ca intake?

A

1g/day

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28
Q

How much Ca is lost in the feces and urine per day?

A

900mg in the poop

100mg in the urine

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29
Q

What is the role of Ca on Na which causes neurvous excitement and tetany?

A

Ca inhibits the permeability of neurons –> low Ca –> ↑ membrane permeability to Na –> easy AP’s

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30
Q

What level do Ca ions drop to in hypocalcemia to cause tetany from normal (9.4mg/dl)?

A

6 mg/dl

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31
Q

What happens to the EKG, appetite, and GI in hypercalcemia?

A

↓ QT interval
↓ appetite
Constipation

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32
Q

At what mg/dl do u see Ca crystals in the body?

A

> 17 mg/dl

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33
Q

What makes up 90-95% of the organic matrix of the bone?

A

collagen fibers

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34
Q

What makes up the remaining 10% of the bone?

A

Ground substance (proteoglycans, like chondroitin sulfate and hyaluronic acid)

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35
Q

What are the cells for bone production?

A

Osteoblasts

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36
Q

What do osteoblasts secrete to build bone?

A

collagen and gorund substance

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37
Q

What do osteoblasts secrete, which is a cytokine, that inhibits bone resorption?

A

OPG

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38
Q

What are the cells for bone resorption?

A

Osteoclasts

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39
Q

What do osteoclasts secrete to eat bone?

A

Proteolytic enzymes and acids (citric acid and lactic acid)

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40
Q

Give me the whole vitamin D synthesis pathway

A

Sun makes cholecalciferol (D3) –liver–> 25-hydroxycholecalciferol –kidney–> 1,25 dihydrocholecalciferol

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41
Q

What are the 3 increases of 1,25 dihydrocholecalciferol?

A

↑ Ca-binding protein
↑ Ca-stimulated ATPase
↑ Alkaline phosphatase

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42
Q

What enzyme does PTH stimulate in the kidney to increase Ca levels in the blood?

A

1-a-hydroxylase

makes 1,25 dihydrocholecalciferol

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43
Q

What suppresses PTH levels?

A

Ca++

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44
Q

What molecule does 1,25 dihydrocholecalciferol cause increased formation of in the GI?

A

Calbindin

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45
Q

What is the role of calbindin in the GI?

A

helps transport Ca into the cell cytoplasm

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46
Q

What other molecule is enhanced by 1,25 dihydrocholecalciferol to be absorbed in the GI?

A

Phosphate

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47
Q

What is the role of 1,25 dihydrocholecalciferol on the nephrons?

A

Increases Ca and phosphate reabsorption

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48
Q

What happens to bone in the presence of 1,25 dihydrocholecalciferol?

A

↑ absorption

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49
Q

Again, which cells of the parathyroid make PTH?

A

Chief cells

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50
Q

Generally, what happens to serum Ca and phosphate under the control of PTH?

A

Ca ↑

Phosphate ↓

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51
Q

This is the rapid phase of bone resorption from PTH, where there is activation of osteocytes to promote Ca and phosphate salt resorption.

A

Osteolysis

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52
Q

Which bone cell does PTH bind to, which stimulates osteolysis?

A

PTH receptor is on osteoBLASTS, which stimulate osteoCLASTS to eat bone.

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53
Q

PTH causes the loss of what substance form the kidney?

A

Phosphate

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54
Q

What is the role of PTH on the kidney for Ca?

A

↑ renal tubular reabsorption

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55
Q

WHERE in the nephron does PTH act to ↑ Ca reabsorption?

A

PCT + DCT + CD

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56
Q

What condition in kids has an increased PTH, which makes them have bad bones?

A

Rickets (↓ vit D)

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57
Q

What female condition can make u have high PTH in the blood?

A

Pregnancy + lactation

Ca is used for breast milk

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58
Q

What is the R in the parathryoid membranes that detects changes in [Ca]?

A

Calcium-sensing receptor (CaSR)

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59
Q

Once the CaSR is stimulated by Ca, what pathway does it use to ↓ PTH release?

A

Gq pathway, which causes the relase of Ca from intracellular stores and in turn ↓ PTH release

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60
Q

What is the H that antagonizes PTH, which ↓ plasma Ca?

A

Calcitonin

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61
Q

What is the stimulus for Calcitonin release?

A

↑ Ca++

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62
Q

In addition to shutting down osteoclasts, what does calcitonin do in kids to save the bone from the evil PTH?

A

↑ bone remodeling

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63
Q

What are the 2 reasons calcitonin doesnt have that big of an effect on adults?

A
  1. any ↓ in serum Ca causes a PTH spike

2. daily Ca intake/use is small

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64
Q

this is the condition where there is inappropriate, excess PTH secretion –> high Ca, low phosphate levels.

A

Primary hyperparathyroidism (HPT)

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65
Q

What is the most common cuase of primary HPT?

A

tumor of the parathyroid gland

66
Q

What are the main problems with primary HPT?

A

Fractures + osteoitis fibrosa cystica

67
Q

What are the Alkaline phosphatase levels in primary HPT?

A

HIGH alkaline phosphatase

68
Q

What do we mean by “stones, bones, andominal groans, psychiatric overtones” in primary HPT?

A

Kidney stones
Bone Fx
Constipation/PUD/↓ appetite
↓ CNS/PNS

69
Q

What is the cuase of secondary HPT?

A

a compensation for hypocalcemia

70
Q

Disease of what organ can cause secondary HPT?

A

Chronic renal disease

no 1,25 dihydrocholecalciferol

71
Q

What is the main cause of lack of vitamin D?

A

Living in Erie

72
Q

What are the Ca levels in the blood in rickets?

A

Low

73
Q

The Ca levels in the blood are low in rickets, but what ion level is extremely low in the blood?

A

Phosphate

low Ca –> ↑ PTH release –> ↑ excretion of phosphate

74
Q

The lack of physical stress on bones from a lack of activity (sitting on yer ass and studying all day) can lead to what problem?

A

Osteoporosis

75
Q

The lack of what vitamin can cause osteoporosis cuz osteoid can’t form corectly?

A

Vitamin C

76
Q

What is the relationship between estrogen and osteoclasts?

A

Estrogen ↓ osteoclasts

this is why postmenopausal women, who dont make estrogen, are at risk for osteoporosis

77
Q

Which cell activity decreases in Cushings?

A

Osteoblasts

78
Q

What FORM of Ca does PTH regulate from the chief cells?

A

Free (ionized) Ca++

79
Q

What is the most common cause of primary HPT?

A

Parathyroid adenoma (>80%)

80
Q

What forms in the kidney in primary HPT?

A

Ca oxalate stones

81
Q

This is a complication of primary HPT where there is metastatic calification of renal tubules, potentially leading to renal insufficicency and polyuria.

A

Nephrocalcinosis

82
Q

Since Ca can activate enzymes, what GI problem can people with primary HPT have?

A

acute pancreatitis

83
Q

What are the changes to the following labs in primary HPT?

Serum PTH
Serum Ca++
Serum Phosphate
Urinary cAMP
Serum Alkaline phosphate
A 
Serum PTH ↑
Serum Ca++ ↑
Serum Phosphate ↓
Urinary cAMP ↑
Serum Alkaline phosphate ↑
84
Q

Which cells cause the ↑ serum alkaline phosphate, as a result of primary HPT?

A

Osteoblasts

(remember these are activated by PTH –> release ALKP to make bone in addition to activation of osteoclasts –> ↑ serum levels in primary HPT)

85
Q

What is the treatment for primary HPT?

A

CUT IT OUT

86
Q

What is the most common cause of secondary HPT?

A

renal insufficiency

87
Q

Renal insufficiency in secondary HPT causes the ↓ exretion of which ion?

A

Phosphate

88
Q

the ↓ excretion of Phospahte in secondary HPT causes what change in serum Ca?

A

serum Ca ↓

because the ↑ serum phosphate binds to it

89
Q

And when the ↑ serum phosphate binds to Ca, and serum Ca levels ↓, what is released as a response?

A

PTH

90
Q

So what happens to the following lab values in secondary HPT?

Serum PTH
Serum Ca++
Serum Phosphate
Serum Alkaline phosphate

A

Serum PTH ↑
Serum Ca++ ↓
Serum Phosphate ↑
Serum Alkaline phosphate ↑

91
Q

What are the 3 main causes of hypoparathyroidism?

A

Autoimmune dmg to parathyroids (hashimotos), surgical excision, and DiGeorge syndrome

92
Q

The low serum Ca in hypoparathyroidism causes what sensory problems?

A

Numbness and tingling (esp around the lips)

93
Q

This is a sign of hypoparathyroidism where there is tetany from filling up a blood pressure cuff.

A

Troussau sign

94
Q

This is a sign of hypoparathyroidism where there is tetany from tapping on the facial n.

A

Chvostek stign

95
Q

What happens to PTH in pseudohypoparathyroidism?

A

↑ resistance to PTH

↓ Gs stimulatory protein

96
Q

What are the serum levels of Ca and PTH in pseudohypoparathyroidism?

A

↓ Ca

↑ PTH

97
Q

The AD form of pseudohypoparathyroidism causes what anatomical defects?

A

Short stature

short 4th and 5th fingers

98
Q

PTH, shear stress, and TGF=B cause osteoblast precursors to express which osteoclast ligand?

A

RANK-L

99
Q

The RANK-L on the osteoblast precursor stimulate which other precursor (which has the RANK)?

A

osteoclast precursor

100
Q

What is the molecule released that causes the osteoclast precursors to differentiate into mature osteoclasts?

A

M-CSF

with stimulation by RANK

101
Q

What is the drug that acts on CaSR, act causes them to activate at lower concentrations?

A

Cinacalcet

102
Q

What are the drugs that lower plasma phosphate by preventing dietary phosphate absorption?

A

Phosphate binders

103
Q

What are the 3 ways that estogen treatment leads to slow bone resorption?

A

Reduces cytokines that induce osteoclasts
Promotes apoptosis of osteoclasts
Inhibits apoptosis of osteoblasts and osteocytes

104
Q

Though estrogen HRT benefits bones, what are the 2 risks of its use?

A

Cardiovascular disease

Breast CA

105
Q

What is the estrogen agonist in bone bu estrogen antagonist in the endometrium and breast?

A

Raloxifene

106
Q

Since raloxifene stimualtes only the bone, what does it bypass the risk in estrogen HRT?

A

Cardiovascular disease

Breast CA

107
Q

What does raloxifine do to LDL levels?

A

Lowers them (helps prevent heart disease)

108
Q

What is the downside to raloxifine?

A

Still increases risk of venous thromboembolism

109
Q

What is the suffix to all bisphosphonates except zoledronic acid?

A

-dronate

110
Q

Where do bisphosphonates accumulate?

A

Bone

111
Q

What do bisphosphonates do in the bone treat osteoporosis, hypercalcemia of malignancy, and Paget’s?

A

osteoclast apoptosis

112
Q

What is the general indication for pamidronate and zoledronate?

A

hypercalemia of malignancy

113
Q

What are the 2 contraindication to pamidronate and zoledronate?

A

dental disease and oral surgery

114
Q

What is the indication for oral aledronate/risedronate?

A

Osteopenia/porosis

115
Q

Bisphosphonates decrease the risk of what fractures?

A

Vertebral

116
Q

Why are bisphosphonates taken orally in the morning on an empty stomach?

A

low oral bioavailability

117
Q

What is the monoclonal Ab against the RANK-L?

A

Denosumab

118
Q

What does calcitonin bind and activate on osteoclasts to decrease their resorptive activity?

A

G-protein R

119
Q

What are the 3 indications for calcitonin?

A

Pagets
Osteoporosis
hyperCa

120
Q

Antiresorptive agents are not helpful in which pts?

A

Thos who have already lost a large amt of bone mass (BMD > SD’s below normal)

121
Q

What makes PTH (1-34) different than normal PTH to increase bone remodeling with more new bone formed than old resorbed?

A

It causes intermittent stimulation of bone cells

122
Q

What do calcium carbonate, calcium acetate, and sevelamer do to dietary phosphate?

A

Bind it and inhibit its absorption?

123
Q

What are the 3 vitamin D congeners that bypass the need for 1-a-hydroxylation in the kidney?

A

Calitrol (1,25(OH)2D3)
Paricalcitrol (19-nor-1,25(OH)2D2)
Doxecalciferol (1a-(OH)D2)

124
Q

What drugs can modulate activity of Ca2+-sensing receptors in chief cells such that they can treat hyperparathyroidism without causing unwanted hypercalcemia & hyperphosphatemia?

A

Calcimimetrics

125
Q

What is the calcimimetric that binds to the transmembrane region of the CaSR and activates it at lower Ca++ concentrations, thus ↓ PTH?

A

Cinacalcet

126
Q

What are the 2 indicaitons for Cinacalcet?

A

secondary HPT

hyperCa with parathyroid carcinoma

127
Q

What population can benefit from Ca supplements, which reduce vertebral bone loss?

A

Postmenopausal women

128
Q

What is the treatment for Viramin D resistant rickets + hypophosphatemia?

A

Oral phosphate and high doses of vit D

Calcitriol is good too

129
Q

What is the treatment for type I vitamin D-dependent rickets?

A

Vitamin D or calcitrol

130
Q

What is the treatment for type II vitamin D-dependent rickets?

A

High dose calcitrol

131
Q

What is the most common cause of hypercalcemia in ambulatory pts?

A

Primary HPT

132
Q

What happens to the parathyroids in familial primary HPT?

A

Hyperplasia of the parathyroids

133
Q

What is the treatment of choice for primary HPT?

A

CUT IT OUT

134
Q

What is the electrolyte abnormality after a surgical parathyroidectomy?

A

Reversible, mild, asymptomatic hypocalcemia

135
Q

This is the cause of hypercalcemia from either destructive effects of malignancy or the paraneoplastic effect of malignancy?

A

Hypercalcemia of malignancy

136
Q

What is the serum PTH levels in hypercalcemia of malignancy?

A

low serum PTH

paraneoplastic syndromes can secrete PTHrp which can cause hypercalcemia –> low PTH

137
Q

This is the cause of hypercalcemia where there is also hypercalciuria, renal insufficiency, and soft tissue calcification.

A

Vitamin D intoxication

138
Q

What enzyme do some lymphomas have to cause hypercalcemia?

A

1a-hydroxylase

139
Q

Hypercalcemia and granulomatous disorders are indications for what treatment?

A

Glucocorticoids

140
Q

What is the type of surgery which may damage the parathryoid glands and cause hypoparathyroidism?

A

Thyroidectomy

141
Q

What is the electrolyte abnormality which impairs secretion of PTH?

A

Hypomagnesemia

142
Q

This is the condition where there is end-organ resistance to the actions of PTH beceause of a receptor or postreceptor defect.

A

Pseudohypoparathyroidism

143
Q

What is the variant of Pseudohypoparathyroidism where the patients have the same characteristic physical features but not the biochemical abnormalities?

A

Pseudopseudohypoparathyroidism

Did you know that this condition (at 30 letters) is the second longest medical word in the dictionary? It’s second to Pneumonoultramicroscopicsilicovolcanoconiosis, which has 45 letters.

144
Q

What is the EKG abnormality in hypocalcemia?

A

prolonged QT

145
Q

What binds to Ca in the blood?

A

Albumin

146
Q

What is the diagnostic test of hypoparathyroidism in a hypocalemic pt?

A

Serum PTH

(hypoparathyroidism with hypocalcemia cuases a low PTH

147
Q

What is the treatment for severe acute hypocalcemia which prevents tetany, stridor, or convulsions?

A

Rapid IV Calcium gluconate

148
Q

This is when u have a bone mass > 2.5 SD’s below the peak bone mass of a sex and height-matched control population?

A

Osteoporosis

149
Q

This is when u have a bone mass 1-2.5 SD’s below the peak bone mass of a sex and height-matched control population?

A

Osteopenia

150
Q

What are the 4 endocrine disorders that can cause osteoporosis?

A

Hypogonadism
HPT
Hyperthyroidism
Hypercortisolism

151
Q

What are the common sites for osteoporotic fractures?

A

Vertebrae, Hip, distal Radius

152
Q

What are the serum levels of Ca, phosphate, and alkaline phosphatase in osteoporosis?

A

Normal

153
Q

What is the test that can be used to assess bone mineral density of the lumbar vertebrae?

A

Dual energy x-ray absorptiometry

154
Q

Diffuse bone pain and tenderness, muscle weakness, and waddling gait are indications for what bone problem?

A

Osteomalacia

155
Q

What are the 3 effective therapies for osteomalacia?

A

Calcium
Vitamin D
Phosphate (when indicated)

156
Q

This is a monostotic or polyostotic bone disorder characterized by the presence of abnormal osteoclasts, which lead to an increased rate of bone resorption and, subsequently, disorganized bone remodeling.

A

Paget disease

157
Q

Which blood test is elevated in Paget disease?

A

Serum alkaline phosphate

158
Q

What are the 3 bones commonly affected by Paget?

A

Long bones, skull, or spine

159
Q

What are the serum levels of calcium, phosphate, and 25-hydroxyvitamin D in Paget?

A

Normal

160
Q

What is the category of drugs used in the medical therapy of Paget?

A

IV Bisphosphonates

Endocrine (4 decks)

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