Parathyroid

Question 0

Lab values that’s suggest primary hyperparathyroidism? Most likely cause? Management?

Answer 0

PTH and serum calcium

Parathyroid adenomas

#Explore the neck and examine the parathyroid glands
#Sestamibi scan to determine site of adenoma (minimally invasive parathyroid surgery)

Question 1

Osteitis fibrosis cystica?

Answer 1

Bone reabsorption

Question 2

Most common location for missing inferior gland on parathyroid exploration?

Location of extra parathyroid gland?

Other locations?

Answer 2

Thymus

tracheoesophageal groove

Intrathyroidal, carotid sheath

Question 3

On the initial exploration in a patient with primary hyperparathyroidism, unable to find adenoma. Next step?

Answer 3

#Localization studies – sestamibi, ultrasound, CT, MRI, angiography
#Reexploration

Question 4

Signs of hypoparathyroidism after surgery?

Answer 4

#Tetany
#Chovstek's sign (Tap facial nerve)

Question 5

Asymptomatic patient with elevation in serum calcium – when to explore parathyroid?

Answer 5

Calcium over 11

Question 6

Differential for causes of hypercalcemia?

Answer 6

Tumors – multiple myeloma, parathyroid adenoma/cancer, renal cell carcinoma, metastatic breast cancer, squamous cell cancer of the lung

Metabolic – hyperthyroidism, milk alkali syndrome, vitamin A intoxication

Inflammatory – sarcoidosis

Genetic – familial hypocalciuric hypercalcemia

Question 7

secondary hyperparathyroidism mechanism?

Answer 7

Chronic renal failure causes retained phosphate. Hyperphosphatemia causes hypocalcemia. Elevated serum PTH

Question 8

When to surgically manage secondary hyperparathyroidism?

Answer 8

Bone pain, fractures, pruritus, ectopic calcifications in soft tissue

Question 9

Common operative findings in secondary hyperparathyroidism?

Surgical management?

Answer 9

Hyperplasia all glands

Excision of all but 50 mg of parathyroid tissue parentheses leave in place, or implant in form)

Question 10

Tertiary hyperparathyroidism?

Answer 10

Patient undergoes renal transplant and has hyperCalcemia postoperatively – parathyroid glands do not respond to return a renal function and continue to produce PTH

3 1/2 gland resection

Question 11

Patient undergoes neck expiration for primary hyperparathyroidism. During the procedure becomes uncontrollably hypertensive – technical causes? Physiologic causes?

Answer 11

Poor ET tube placement, inadequate oxygenation, inadequate anesthesia

Pheochromocytoma