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ClinMed exam III > Parathyroid > Flashcards

Parathyroid Flashcards

1
Q

What regulates calcium in the body?

A
  • PTH
  • calcitonin
  • active vitamin D
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2
Q

What body systems utilize calcium?

A
  • nervous
  • muscular
  • skeletal
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3
Q

Where is most of the body’s calcium stored

A

in the bones (99%)

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4
Q

What are the three forms of calcium that circulate in the blood

A
  • free ionized form (active)
  • bound to protein
  • complex aniions
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5
Q

What is the normal total serum calcium

A

8.5-10.5 mg/dL

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6
Q

What is the net effect of parathyroid hormone

A
  • increase serum calcium

- decrease serum phosphate

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7
Q

What is the active form of vitamin D

A

calcitriol

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8
Q

Net effect of calcitriol

A
  • increase serum calcium

- increase serum phosphate

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9
Q

What does calcitriol do in the intestine

A

enhances intestinal cells to absord calcium and phosphate into the serum

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10
Q

Body response to low serum Ca in the bone? kindey?

A

bone: PTH stimulated osteoclastic activity which leads to increased serum CA
kidney: PTH promotes Ca resorption and stimultes hydroxylation of 25-hydroxyvitamin D via an enzyme

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11
Q

Body’s response to high serum Ca

A

parathyroid decreases PTH production

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12
Q

PTH response to increased serum calcium

A

PTH levels decrease

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13
Q

PTH response to decreased serum calcium

A

PTH levels increase

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14
Q

What does PTH do in the bone

A
  • activates osteoclastic activity to increase serum calcium

- inhibits osteoblastic activity

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15
Q

What does active vitamin D do in the bone

A

promotes osteoblactic activity

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16
Q

What does calcitonin do in the bone

A

activates osteoblastic activity to decrease serum calcuim

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17
Q

What does the kidney do to maintain calcium homeostatsis

A
  • reabsorbs calcium
  • secretes phosphate in the urine
  • increases serum alpha hydroxylase in order to convert calcidiol into calcitriol
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18
Q

Most common cause of hypocalcemia in adults

A

renal failure

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19
Q

Most common cause of hypocalcemia in children

A

nutritional deficiencies

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20
Q

Average age of hypoparathyroidism diagnosis

A

5th decade

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21
Q

Why is hypocalcemia from hypoparathyroidism rare

A

it requires all 4 parathyroid glands to be affected

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22
Q

Etiology of hypoparathyroidism

A 
PARATHYROIDECTOMY
THYROIDECTOMY
-extensive raditation to neck
-autoimmune
-congenital
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23
Q

Symptoms of hypocalcemia

A
  • emotional lability
  • paresthesia
  • shortness of breath
  • voice changes
  • vision changes
  • personality changes
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24
Q

Physical exam findings with hypocalcemia

A
  • seizures
  • arrhythmia
  • stridor
  • tetant
  • psychosis
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25
Q

What is Trousseau sign

A

flexion of the wrist and fingers

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26
Q

What is chvotek sign

A

abnormal reaction of the cranial nerves to stimulation on the face

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27
Q

What diagnostics are done for hypocalcemia? what do they show?

A
  • EKG: qtc prolongation
  • Total calcium (corrected calcium for low albumin): low
  • PTH: low
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28
Q

Measuring calcidiol levels looks for what

A

liver dysfunction

29
Q

What levels do you measure for kidney dysfunction

A

active vitamin D (calcitriol)

30
Q

Treatment for hypocalcemia

A
  • oral calcium (calcium carbonate)

- IV calcium (calcium gluconate)

31
Q

What is the most common electrolyte abnormality in adults with malignancies

A

hypercalcemia

32
Q

What is the most common cause of hypercalcemia

A

hyperparathroidism

33
Q

What oncogene is linked to hyperparathyroidism

A

MEN 1, 2A and 2B

34
Q

Etiologies for hypercalcemia

A 
S.H.A.M.P.O.O
sarcoidosis
hyperparathyroid
alkali milk syndrome
metastasis
pagets disease
osteogenesis imperfecta
osteoperosis
D.I.R.T
d vitamin intoxication
immobility
renal tubular acidosis
thiazides
35
Q

Eitology of primary hyperparathyroid

A
  • parathyroid adenoma
  • hyperplasia
  • carcinoma
  • familial hypocalciuric hypercalcemia
36
Q

Etiology of secondary hyperparathyroid

A
  • chronic renal failure

- vitamin D deficinecy

37
Q

Signs and symptoms of hypercalcemia

A

“bones, stones,groans, moans, psychiatric undertones”

38
Q 
Exam findings for hypercalcemia.
   skin
   cardiac
   GI
   renal
   MSK
   Neuro
A

exam is usually non contributory
skin: prutitus, skin tenting
cardiac: hypertension, LVH
GI: anorexia, N/V, constipation, abd pain
Renal: renal colic
MSK: bone fracture
Neuro: paresthesias, muscle weakness, depression

39
Q

Diagnostic tests for hypercalcemia/hyperparathyroid

A
  • calcium level
  • PTH
  • 24hr urinary calcium excretion
  • chloride, phosphate
  • PTHrP (malignancy)
  • Bun/creatinine
  • calcitriol/calcidiol
  • EKG (narrow qtc)
40
Q

Calcium, PTH and phosphate levels in primary hyperparathyroid

A

calcium- high
PTH- high
phosphate- low

41
Q

Calcium, PTH and phosphate levels in secondary hyperparathyroidism

A

calcium- low to normal
PTH- high
phosphate- high to normal

42
Q

Calcium, PTH and phosphate levels in secondary hyperparathyroidism

A

calcium- high
PTH- super high
phosphate- high

43
Q

PTH release is increased by

A
  • hypocalcemia
  • hyperphosphatemia
  • catecholamines
44
Q

PTH is release is suppressed by

A
  • hypercalcemia
  • vitamin D
  • severe hypomagnesemia
45
Q

Scans done for hyperparathyroidism

A
  • sestamibi scan

- US of the neck

46
Q

Treatment options for hyperparathyoidism

A
  • surveillance
  • surgical
  • pharmacological
  • supportive
47
Q

Medical treatment for hyperparathyroid

A

ASYMPTOMATIC PTS

  • hydrate, avoid immobilization
  • modest dietary calcium
  • bisphosphonates
  • d/c thiazides, vitamin A, calcium containing antacids
48
Q

What is required for asymptomatic patients with hyperparathyroidism

A

annual serum calcium and creatinine

bone density scans every 1-2 years

49
Q

What makes someone a surgical candidate for hyperparathyroidism

A
  • symptomatic
  • under the age of 50
  • pregnant
  • CrCl <60
  • 24 hr urine calcium >400
  • presence of nephrocalcinosis
  • osteoperosis
50
Q

Medications for treatment of hypercalcemia

A
  • normal saline (dilution)
  • loop diuretics w/ increased hydration
  • bisphosphonates (inh osteoclastic)
  • calcitonin (inh osteoclasts, promotes osteoblasts)
  • gallium nitrate (direct inh of bone resorption)
51
Q

Bisphosphonates used for hypercalcemia

A
  • pamidronate

- zoledronic acid

52
Q

Most common symptoms of hyperparathyroid

A
  • nephrolithiasis
  • fatigue
  • bone disease
53
Q

Genetic predisposition for parathyroid cancer

A

MEN1 and 2A

54
Q

When is parathyroid cancer suspected

A

if symptoms are severe

  • Ca levels >14
  • PTH 5x normal
  • palpable parathyroid
55
Q

Treatment of parathyroid cancer

A

bilateral neck exploration with excision of tumor and ipsilateral thyroid lobe

56
Q

How to treat parathyroid cancer with nodal involvement

A

radical neck dissection

57
Q

When to check Ca levels after parathyroid cancer surgery

A
  • 2 weeks post op
  • 6 months
  • anually
58
Q

What is pagets disease

A

localized disorder of bone remodeling with excessive bone resorption followed by disorganized bone formation

59
Q

What are the three phases of paget disease

A
  1. lytic
  2. mixed
  3. sclerotic phase
60
Q

What happens during the lytic phase of paget disease

A

osteoclasts are more numerous and larger than normal

HIGH bone turnover

61
Q

What happens during the mixed phase of paget disease

A

rapid increase in bone formation from numerous osteoblasts

62
Q

What happens during the sclerotic phase of paget disease

A

bone if formed in a disorganized, woven pattern and is therefor weaker than normal

hypervascular bone state

63
Q

Most common symptoms of paget disease

A

PAIN

  • pathologic fracture
  • osteoarthritis
  • nerve impingement
  • hearing loss
64
Q

How is paget disease often diagnosed

A

accidentally by radiography or elevated alk phos

65
Q

Treatment for paget disease

A
  • surveillance for asymptomatic pts
  • bisphosphonates
  • calcitonin (intolerant to bisphosphonates)
  • calcium
  • vitamin D
66
Q

Which bisphosphonates are used for paget disease

A
  • zolendronic acid
  • pamidronate
  • risendronate
  • alendronate
67
Q

Preferred bisphosphonate for extensive disease or the elderly

A

IV zolendronic acid

68
Q

Preferred disphosphonate for less extensive disease/young patients

A

risendronate or alendronate

ClinMed exam III (7 decks)

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