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clin med IV > parathyroid > Flashcards

parathyroid Flashcards

1
Q

role of PTH

A
  • maintain serum Ca levels
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2
Q

where does PTH act

A
  • bone
  • kidneys
  • intestines
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3
Q

PTH action on bone

A
  • stimulate osteoclasts -> Ca resorption
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4
Q

PTH action on kidneys

A
  • enhance Ca reabsorption

- synthesize active vit d

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5
Q

PTH action on intestines

A
  • active vit D increases GI absorption of Ca
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6
Q

where is the majority of Ca found?

A
  • 99% in bones
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7
Q

serum Ca

A
  • only 1% of all Ca
  • half is active
  • half is bound to albumin
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8
Q

how do you calculate corrected Ca

A
  • Ca measured + [0.8 (4 - measured albumin)]
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9
Q

calcitonin

A
  • produced by thyroid gland
  • opposes PTH
  • “tones down” serum Ca
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10
Q

hungry bone syndrome

A
  • parathyroid removal -> Ca influx into bones

- causes hypocalcemia

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11
Q

tx for hungry bone syndrome

A
  • PO Ca

- IV Ca if severe- chvostek’s or trousseaus sign, seizures, arrhythmias

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12
Q

hypoparathyroidism

A
  • rare
  • need all 4 parathyroid glands to be affected
  • d/t thyroid/parathyroidectomy, radiation, autoimmune, genetic
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13
Q

what is the most common cause of hypocalcemia in adults

A
  • renal failure

- kidneys dont activate vit D

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14
Q

what is the most common cause of hypocalcemia in kids

A
  • nutritional deficiencies
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15
Q

si/sx of hypoCa

A
  • convulsions
  • arrhythmias- QT prolongation
  • tetany
  • stridor
  • spasms
  • paresthesias
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16
Q

PE findings for hypoCa

A
  • chvostek’s sign
  • trousseau’s sign
  • hyperreflexia
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17
Q

treatment for hypoCa and hypoparathyroidism

A
  • PO calcium
  • IV calcium if severe
  • Vit D if hypopara, hungry bone syndrome, vit d def
  • 1,000- 1,200 mg Ca daily
  • Mg PRN
18
Q

hypercalcemia

A
  • common metabolic emergency

- assoc with up to 40% of cancer pts

19
Q

what is the most common cause of hyperCa

A
  • hyperparathyroidism
20
Q

primary hyperparathyroidism

A
  • single parathyroid adenoma
  • hyperplasia
  • carcinoma
  • familial hypocalciuric hypercalcemia
21
Q

secondary hyperparathyroidism

A
  • CKD or vit D def -> increased PTH to try to increase Ca
22
Q

tertiary hyperparathyroidism

A
  • PT hyperplasia from prolonged secondary hyperPT -> increased PTH
  • PTH elevated even after problem has been fixed
23
Q

si/sx of hyperCa and hyperPT

A
  • bones, stones, groans (abd), moans (psych)
24
Q

hyperparathyroid imaging

A
  • not used to make dx
  • sestambi scan
  • US
  • CT
  • MRI
  • DXA scan
  • Xray
25
Q

xray findings for hyperparathyroidism

A
  • osteitis fibrosa cystica
  • salt and pepper skull
  • brown tumor of long bones
26
Q

surgical requirements for hyperparathyroidism

A
  • age < 50
  • serum Ca >1 above normal
  • bone density < -2.5
  • vertebral fx
  • CrCl < 60
  • 24 hour urine Ca > 400
  • renal stone risk or evidence of stones
  • symptoms
  • pt preference
27
Q

medical tx in asymptomatic hyperparathyroidism

A
  • fluids
  • modest dietary Ca
  • Vit D based on age
  • bisphosphonates
  • d/c thiazides, vit A, Ca antacids
28
Q

medical tx in symptomatic hyperparathyroidism

A
  • fluids
  • furosemide
  • IV bisphosphonates
  • calcitonin
  • cinacalcet
  • propranolol
29
Q

ADRs of bisphosphonates

A
  • AKI
  • osteonecrosis of the jaw
  • msk pain
  • esophagitis
30
Q

parathyroid ca

A
  • least common endocrine malignancy
  • MEN1 and MEN2A
  • Ca levels > 14 and PTH normal
31
Q

treatment for parathyroid ca

A
  • surgical excision

- if nodal involvement - radical neck dissection

32
Q

post op care for parathyroid ca

A
  • check PTH and Ca at week 2, 6 mo, annually

- recurrence occurs 2-5 years post op

33
Q

bones affected by paget disease

A
  • skull
  • thoracic and lumbar spines
  • sacrum
  • pelvis
  • femur
  • tibia
34
Q

how is paget disease dx

A
  • usu found incidentally
  • imaging
  • elevated alk phos
35
Q

phases of paget disease

A
  • lytic
  • mixed lytic and blastic
  • sclerotic
36
Q

lytic phase of paget disease

A
  • osteoclasts are more numerous and larger

- turnover is 20X higher

37
Q

mixed lytic and blastic phase of paget disease

A
  • rapid increase in bone formation but it is disorganized
38
Q

sclerotic phase of paget disease

A
  • disorganized bone formation dominates
  • bone marrow infiltrated by CT nd BV
  • bone is weaker than normal
39
Q

si/sx of paget disease

A
  • most asymptomatic
  • pain most common sx if present
  • bowed tibias
  • kyphosis
  • HA, hearing loss, increased hat size
40
Q

complications of paget disease

A
  • hearing loss
  • pain, arthritis
  • vertebral collapse/ fx
  • CN palsies
  • paralysis
41
Q

treatment in asymptomatic paget disease

A
  • surveillance
42
Q

treatment in symptomatic pagets

A
  • bisphosphonates
  • calcitonin
  • Ca and Vit D
  • measure serum alk phos

clin med IV (23 decks)

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