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endocrine > parathyroid > Flashcards

parathyroid Flashcards

1
Q

PTH 3 functions

A
  • mobilize calcium from bones by osteoclast stimulation
  • stimulates kidneys to resorb calcium
  • increases GI absorption of calcium
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2
Q
  • what causes 85% of primary hyperparathyroidism

- other 15%

A
  • benign parathyroid gland adenomas

- parathyroid gland hyperplasia

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3
Q

hyperparathyroidism

  • gender
  • age
A

women 2:1 ratio

incidence increases after age 50

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4
Q

what occurs with chronic kidney disease and why

A

secondary hyperparathyroidism occurs due to hyperphosphatemia, causing increased ionized calcium levels, and decreased renal production of active vitamin D

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5
Q

mild hypercalcemia symptoms

A

asymptomatic

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6
Q

thirst, anorexia, depressed DTR, N/V, abd pain, constipation, fatigue, anemia, wt loss, peptic ulcer disease, pancreatitis, HTN

A

severe hypercalcemia symptoms

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7
Q

stones, bones, groans, moans

A
  • renal loss of Ca and phosphate= kidney stones
  • bone loss from PTH= pain in bones
  • increase GI absorption and abd cramps= groans
  • irritability, psychosis, depression= moans
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8
Q

pathologic fractures occur where usually

A

jaw

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9
Q

hypercalcemia induced nephrogenic diabetes insipidus symptoms

A

polydipsia and polyuria

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10
Q

hypercalcemia in relation to urine calcium

A

urine calcium excretion is low for hypercalcemia

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11
Q

what labs confirm hyperparathyroidism

A

elevated serum levels of intact PTH

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12
Q

what labs confirm a secondary disorder of PTH such as malignancy

A

elevated calcium with low PTH

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13
Q

what labs indicate parathyroid cancer

A

extreme elevations of both calcium and PTH

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14
Q

what to do before treating hyperparathyroidism

A

screen for familial benign hypocalciuric hypercalcemia with a 24 hr urine for calcium and creatinine

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15
Q

pts with low bone mineral density, normal serum calcium, elevated PTH

A

should be assessed for secondary hyperparathyroidism from vitamin D or calcium deficiency, hyperphosphatemia, or renal failure

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16
Q

EKG with hyperparathyroidism

A

prolonged PR interval, shortened QT interval, bradyarrhymias, heart block, asystole

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17
Q

treatment for mild asymptomatic primary hyperparathyroidism

A

stay active, avoid immobilization, drink adequate fluids

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18
Q

hyperparathyroidism pts should avoid what

A

thiazides, large doses of vitamin A and D, and calcium containing antacids, and supplements

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19
Q

monitor hyperparathyroidism with what tests

A 
serum calcium
serum albumin
kidney function
urinary calcium excretion
bone density studies
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20
Q

what can temporary measure to decrease serum calcium

A

bisphosphonates; with cautious administration of vitamin D

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21
Q

acute hypercalcemic crisis

A

IV hydration and bisphosphonates; furosemide may promote urinary calcicum excretion

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22
Q
  • tx for symptomatic primary disorder-hyperparathyroidism

- what can occur post operatively

A
  • parathyroidectomy

- hypocalcemia and transient hyperthyroidism may occur post op

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23
Q

hypercalcemia symptoms

A

proximal muscle weakness, gait disturbances, atrophy, hyperreflexia

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24
Q

acquired hypoparathyroidism most commonly from what

A

following parathyroidectomy or thyroidectomy

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25
Q

heavy metal toxicity can cause what

A

hypoparathyroidism

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26
Q

hypomagnesium can cause what

A

hypoparathyroidism

27
Q

What is DiGeorge syndrome

A

congenital cause of hypocalcemia arising from parathyroid hypoplasia, thymic hypoplasia and outflow tract defects of the heart

28
Q

congenital pseudohypoparathyroidism results from what

A

a group of disorders characterized by alterations in serum calcium related to resistance to PTH

29
Q

tetany, carpopedal spasms, mm or abd cramps, paresthesias as well as teeth, nail, and hair defects, HYPERreflexia

A

hypocalcemia

30
Q

hypocalcemia signs

A

tetany, carpopedal spasms, mm or abd cramps, paresthesias as well as teeth, nail, and hair defects, HYPERreflexia

31
Q

chvostek sign

A

contraction of eye, mouth, nose muscles, elicted by tapping along the course of the facial nerve anterior to the ear

32
Q

trosseau sign

A

produces spasm in the hand and wrist with compression to the forearm

33
Q

lethargy, anxiety, parkinsonism, mental retardation, personality changes, blurred vision caused by cataracts

A

severe chronic hypoparathyroidism

34
Q

hallmark to hypoparathyroidism

A

decreased PTH and adjusted serum calcium, and increased phosphate levels
[serum magnesium may be low, alk phos nml]

35
Q

EKG in hypoparathyroidism

A

prolonged QT intervals and t wave abnormalities

36
Q

radiographs in hypoparathyroidism

A

chronic increased bone mineral density, especially in the lumbar spine and skull

37
Q

hypoparathyroidism tx

A

correct hypocalcemia with Ca and Vit D. Mag supp may be required

38
Q

how to monitor tx of hypoparathyroidism

A

measurement of adjusted serum and urine calcium levels

39
Q

avoid what drugs with hypoparathyroidism

A

phenothiazines and furosemide due to risk of further calcium loss

40
Q

what is emergency tx of tetany

A

airway maintenance and slow administration of IV calcium gluconate

41
Q

An adenoma of the parathyroid does what

A

An adenoma leads to excessive secretion of parathyroid hormone.

42
Q

Chronic renal failure and poor production of vitamin D which will cause what

A

Chronic renal failure and poor production of vitamin D which will decrease Calcium, thereby stimulating the parathyroid glands

43
Q

hyperparathyroidism

Blood work

A

Ca > 10.5
elevated PTH is diagnostic
phosphate low less <2.5 in primary disease. Elevated in secondary disease
low vitamin D

44
Q

hyperparathyroidism

Urine

A

Ca elevated

phosphate elevated

45
Q

hyperparathyroidism

Imaging

A
  • CT/ MRI not helpful
  • U/S is far more sensitive though not necessary
  • X-ray: demineralization
    subperiosteal bone resorption especially in the fingers
    cysts of the jaw; salt and pepper skull
  • DXA scan may help determine amount of bone loss
46
Q

hyperparathyroidism surgical tx

A

Surgical removal 94% successful

parathyroidectomy is the recommended treatment for symptomatic and some asymptomatic patients

47
Q

complication of parathyroidectomy

A

hypocalcemia

48
Q

Hyperthyroidism and hyperparathyroidism

A

Hyperthyroidism may result from physical manipulation of the thyroid- propranolol if necessary

49
Q

Medical treatment of hyperparathyroidism

A

Fluid, Fluid, Fluid — admission and IV fluid if necessary
IV Bisphosphonates
Pamidronate
Zoledronic Acid
Cinacalcet — a calcimimetic
Vitamin D
Estrogen decreases serum Ca in a postmenopausal hyperparathyroidism
Propranolol may be used to protect the heart against elevated Ca

50
Q 
Heavy metal damage
Low Mg
Granulomas
Tumors
Infection
Reidel’s thyroiditis
Post thyroidectomy is the most common
Post parathyroidectomy
A

can all cause hypoparathyroidism

51
Q

Autoimmune hypoparathyroidism

A

may occur alone in combination with other autoimmune disorders like lupus or Addison’s disease.

52
Q 
irritability
tetany  — the involuntary contraction of muscles
carpopedal spasms
cramping
convulsions
tingling
circumoral
distal extremities
A

acute hypoparathyroidism

53
Q 
Lethargy
parkinsonism
mental retardation
anxiety
changes in personality
cataracts → blurred vision
dry skin
decreased eyebrow hair
Nail and teeth defects — brittle nails
hyperreflexia (possible)
A

chronic hypoparathyroidism

54
Q 
Ca low
Corrected Ca will be low  (Ca is mostly bound to albumin so if albumin is low you need a corrected Ca)
Urinary Ca low
Parathyroid hormone is low
Mg low
A

hypoparathyroidism

55
Q
  • CT or x-ray may show dense bones
    cutaneous calcifications, calcifications of basal ganglia
  • EKG: prolonged QT, T wave abnormalities
  • Slit-lamp: early cataract formation
A

hypoparathyroidism

56
Q

hypoparathyroidism treatment

A

Emergently: airway maintenance and IV calcium gluconate

Followed by: Mg if appropriate
Ca supplement
Vitamin D supplement
Close monitoring of Ca

57
Q

pseudohypoparathyroidism

A

In pseudohypoparathyroidism you make parathyroid hormone, but the receptors don’t respond to it.

58
Q

pseudohypoparathyroidism Blood work

A

Ca will be low

Parathyroid hormone is elevated

59
Q

pseudohypoparathyroidism treatment

A

Cases are typically not as severe as true hypoparathyroidism
Ca supplement
Vitamin D supplement

60
Q

X-ray: salt and pepper skull; demineralization
subperiosteal bone resorption especially in the fingers
cysts of the jaw

A

hyperparathyroidism

61
Q

hyper or hypoparathyroidism can cause cataracts

A

hypo- do slit lamp

62
Q

QT interval for hyper and hypoparathyroidism

A

hyper is shortened

hypo is prolonged

63
Q

hyper and hypoparathyroidism

which has t wave abnormalities, bradyarrhythmias, hrt block, asystole?

A

hypoparathyroidism has t wave abnormalities

hyperparathryroisim has bradyarrhythmias, hrt block, and asystole

endocrine (9 decks)

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