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Surgery Final > Parathyroid > Flashcards

Parathyroid Flashcards

1
Q

Where are the superior parathyroid glands located?

A

4th branchial pouch

Constant location

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2
Q

Where are the inferior parathyroid glands located?

A

3rd branchial pouch

Variable location: can be in heart or even sinuses

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3
Q

Blood supply to parathyroid glands?

A

Superior thyroid artery

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4
Q

What does parathyroid hormone do?

A

Stimulates osteoclasts
Increases calcium concentration through renal and GI absorption (synthesis of D3)
Phosphate excretion

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5
Q

What role in calcium regulation does Vitamin D play?

A

Stimulates intestinal absorption of calcium

Deficiency causes increase in PTH (secondary cause of hyperparathyroidism)

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6
Q

What hormone inhibits parathyroid hormone?

A

Calcitonin (C cells of the thyroid)

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7
Q

What causes most hypercalcemia in a hospital setting?

A

Cancer

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8
Q

What causes most hypercalcemia in an outpatient setting?

A

Hyperparathyroidism

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9
Q

What are some triggers for hypercalcemia?

A 
Family history, MEN syndrome
HTN
PUD
Vitamin D deficiency
Early osteoporosis
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10
Q

Symptoms of hyperparathyroidism?

A 
Stones
Renal failure
Bone pain, osteoporosis
Polyuria, constipation
Depression
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11
Q

Is hyperparathyroidism more common in men or women?

A

3:1 women to men

Near menopause

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12
Q

What are symptoms of hypercalcemic crisis?

A

Anorexia, weakness, vomiting
Acute pancreatitis
Dehydration (along with polyuria, polydipsia)
Mental status changes

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13
Q

Treatment for hypercalcemic crisis?

A

IV fluids
Loop diuretic (gets rid of calcium)
Bisphosphonates
-Calcitonin, Mithramycin?

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14
Q

Lab findings in hyperparathyroidism?

A

Calcium high
Phosphorous low
PTH

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15
Q

Causes of hyperparathyroidism?

A

Single gland-85%
Diffuse hyperplasia-10-12%
Double adenoma-1-2%
Carcinoma-<1%

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16
Q

How do we treat familial hypocalciuric hypercalcemia (FHH)?

A

No need to operate

Normal in family

17
Q

Single best test for locating abnormal parathyroid glands?

A

Sestamibi scintigraphy

18
Q

Initial imaging for parathyroid glands?

A

US

19
Q

What imaging is useful for locating parathyroid glands in the mediastinum or transesophageal groove?

A

4D CT scan

20
Q

What expensive imaging very sensitive when it comes to finding parathyroid glands?

A

MRI

-Use if all others fail

21
Q

What are indications for parathyroid surgery in asymptomatic patients?

A 
Serum calcium level over 11.5
Creatinine clearance less then 30% of normal
24 hr urine calcium >400
Bone mass < 2 SDs from normal
Young patients who request surgery
22
Q

What PTH level is abnormal?

A

> 65

23
Q

What is gold standard treatment for primary hyperparathyroidism?

A

Central neck exploration/Parathyroidectomy

-Do a rapid parathyroid test during procedure (over 65?)

24
Q

Treatment for parathyroid hyperplasia?

A

Less successful
3.5 gland parathyroidectomy
4 gland parathyroidectomy w/ autograft to forearm (patient is without PTH for 6 months until graft kicks in)

25
Q

Secondary causes of hyperparathyroidism?

A

Vit D deficiency
Rickets
Renal failure
Lithium

26
Q

Tertiary cause of hyperparathyroidism?

A

After renal transplant

27
Q

Risk factors for parathyroid carcinoma?

A

> Age 50
MEN syndrome
Radiation exposure

28
Q

Treatment for parathyroid carcinoma?

A

Parathyroidectomy w/ ipsilateral thyroid lobectomy and central compartment dissection

29
Q

Complications of parathyroid carcinoma?

A

If recurrent laryngeal is affected, patient may be hoarse or have pneumonia

30
Q

Postoperative treatment of parathyroidectomy?

A

Calcium may be low: treat when <8 (symptoms)

  • IV calcium
  • D3 (Rocaltrol) for Ca absorption
  • HCTZ
  • Phoslo-lowers phosphate and increases calcium

Surgery Final (5 decks)

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