Parathyroid

Question 1

What is the function of the parathyroid gland

Answer 1

Regulates calcium homeostasis and negative feedback with calcium receptor on surface
Regulates phosphate

Question 2

How is calcium regulated

Answer 2

When serum calcium lowers, stimulates PTH which reabsorbs calcium into blood
When serum calcium is high, calcitonin is released which causes calcium to be reabsorbed by bones

Question 3

What are they types of hypoparathyroid

Answer 3

Acquires (MC) 2/2 post-thyroidectomy (or neck irradiation)
AI
congenital

Question 4

How does hypoparathyroid present clinically

Answer 4

tetany 
cramps
carpopedal spasm 
AMS 
stridor 
Chvostek sign, Trousseau (low Ca) 
cataracts, brittle nails, dry scaly skin, candidiasis, hyperactive DTR

Question 5

Expected hypoparathyroid labs are

Answer 5

Low calcium 
High phosphate 
Low urine calcium 
normal Alk phos 
Low PTH 
Low-norm magnesium

Question 6

How do you emergently treat acute tetany

Answer 6

IV calcium gluconate + oral calcitriol (wean to oral Ca)

Airway maintenance

Question 7

How do you maintain hypoparathyroidism

Answer 7

Oral calcium + Vitamin D
avoid hypercalcemia
2nd line Tx: recombinant hPTH

Question 8

What are the types of primary hyperparathyroid

Answer 8

parathyroid adenoma (MC) 
PTH hyperplasia/carcinoma (rare)

Question 9

What are the types of secondary hyperparathyroid

Answer 9

chronic renal failure (high serum phosphate + low renal Vit D= low calcium)
renal osteodystrophy
*Another hyperparathyroid cause is multiple endocrine neoplasia (MEN)

Question 10

How does hyperparathyroid present

Answer 10

MC: Asymptomatic!
Rare: bone, stones, abdominal groans, psych moans, with fatigue overtones
-polyuria/dipsia, distal RTA, nephrogenic diabetes indipidus
-anorexia, n/v, constipation, PUD, pancreatitis
-confusion, fatigue, stupor, coma
-weak muscle, bone pain, osteopenia/porosis
showr QT, bradycarda, HTN

Question 11

DDx for hyperparathyroid is

Answer 11

Malignancy! (high calcium is cancer until proven otherwise)

Familial hypocalciuric hypercalcemia

Question 12

How do you diagnose hyperparathyroid

Answer 12

elevated Ca
elevated PTH
urinary calcium excretion

Question 13

How do you treat hyperparathyroidism

Answer 13

parathyroidectomy is definitive! (surgical resection)
conservative: physical activity, drink enough fluid, avoid lithium and HCTZ, restrict Ca intake to 1000mg, 400-600 Vitamin D, monitor well

Question 14

Medical management of primary hyperparathyroid is

Answer 14

IV bisphosphanates (Zoledronic acid AKA Reclast) to temp. decrease hypercalcemia and Tx bone pain

Question 15

Medical management of secondary/tertiary hyperparathyroid is

Answer 15

Cinacalcet (sensipar)- mimics calcium

Parcalcitol (zemplar)