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Endocrine > Parathyroid > Flashcards

Parathyroid Flashcards

1
Q

Chotzeks sign

Trausseau’s sign ypocacemic tetany

A

Chotzeks sign - tap on facial nerves > corner of mouth twitch

Trausseau’s sign - BP cuff >20mmHg above systolic > clawed spasm

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2
Q

in PTH resistance, serum phosphorus is

A

high normal

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2
Q

Excess/deficiency of FGF23 can cause…

A

Excess: hypophosphatemia

imparied bone mineralization (genetic ricketts, tumor-induced osteomalcia)

Decreased - hyperphosphatemia and tumor calcinosis (calcified masses)

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3
Q

FGF423 action

A

made by osteocytes

increases urinary phosphate excretion

decreases renal production of 1,25(OH)2D

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4
Q

in hypoparathyroidism

Serum Ca

Serum PO4-

Intact PTH

25-OHD3-

A

Serum Ca - low

Serum PO4 - high/normal

Intact PTH = low normal

25-OHD3 -normal

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4
Q

in pseudohypoparathyroidism

Serum Ca

Serum PO4 -

Intact PTH

25-OHD3 -

A

Serum Ca low

Serum PO4 -high normal

Intact PTH high

25-OHD3 - normal

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6
Q

most common cause of PTH INdependent hypercalcemia

A

cancer and granulomatous diseases

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6
Q

primary hypocalcemia caused by

secondary

A

deficiency in PTH secretion

secondary - renal failure - cannot produced adequate 1,25(OH)D)

malabsorption

vitamin D deficiency

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7
Q

highly regulated step 1-hydroxylating 25(OH)D to 1,25(OH)D is stimualted by

A

PTH

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8
Q

in PTH independent hypercalcemia, PTH is usually

A

supressed

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8
Q

pseudohypoparathyroidism =

A

resistnace to PTH

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10
Q

Treatment of Hypercalcemia

A

IV fluids - normal saline

Loop diuretics (Furosemide) (augemnt Ca2 exretion)

Calcitonin - rapid reduction in Ca2 (escape occurs in several days)

Bisphosphonates - inhibit osteoclastic boen reabsorption

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11
Q

Familial hypocalciuric hypercalemia findings

A

asymptomatic lifelong hyercalcemia

hypocalciuria

PTH not surpressed

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13
Q

in secondary hyperparathrydoism

Serum Ca

Serum PO4 -

Intact PTH

25-OHD3 -

A

Serum Ca - low

Serum PO4 - low normal

Intact PTH - High

25-OHD3 - low

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14
Q

in magnesium depletion

Serum Ca

Serum PO4 -

Intact PTH

25-OHD3 -

A

Serum Ca - low

Serum PO4 -normal

Intact PTH - low normal

25-OHD3 - N

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15
Q

Familial hypocalciuric hypercalcemia genetics

A

AD

FHH1 most familes (CaSR on chromosome 3)

not all FHH have CaSR mutations

16
Q

PTH-indepednet hypercalcemia etiology

A

Malignancy - bone metastes, PTH-related protein, osteoclast activating factors, unregulated calcitriol production, ectopic PTH

Calcitriol mediated granulomatous, inflammatory

Hyperthyroidism

Milk-alkali syndrome or calcium-alakli syndrome (CaCO3 over dose)

imobilization

17
Q

deactivates 25D

A

24-hydroxylase

18
Q

symtpoms hypocalcemia

A

Neuromusuclar iratability - parathesias, muscle cramps, tetany,

lowered seizure threshold

mental status changes

prolonged QT, arrhythmias, CHF

basal ganglia calcification

cataracts

Chvosteks and trousseasus sign

19
Q

treatment of hypocalcemia

A

IV calcium gluconate (initially)

Vitamin D2, D3, calcitriol

21
Q

most common cause of PTH dependent hypercalcemia

A

hyperparathyroidism

22
Q

2 underlying mechanisms of ECF volume contraction ion hypercacemia

A

Anorexia, nausea, vomiting

renal salt and water loss

23
Q

in secondary hyperparathyroidism, serum phosphorus is

A

low normal (unless from renal failure, then it is low high)

24
Q

skeletal morphology in primary hyperparathyroidism

A

BMD decreased preferentially at cortical sites

fractures increased

25
Q

Calcimimetic (cinacalcet) can be used to treat

A

severe hyperparathyroidism

26
Q

Calcitriol (1,25OH2D) mediated hypercalcemial =

found in:

A

non-renal/unregulated expression of 1-hydroxylase

sarcoid

lymphoma

tubercuolosis

27
Q

findings in primary hyperparathyroidism

A

decreased sensitivity of PTH secreting cells to inhibition by Ca

increased/inappropriately not supresssed PTH

Hypercacelmia (bone resorption, calcium reabsorption, increase in 1,25D production in kidneys)

Hypophosphetemia - phosphaturic effects

**some patients Hypercaciuric **(filtered load exceeds Tm for reabsorption)

Endocrine (45 decks)

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