Parathyroid Flashcards
What is the definition of hyperparathyroidism?
Abnormally high levels of PTH secreted in response to low levels of calcium
How is calcium levels in the blood controlled?
Via a negative feedback system in response to low calcium that increases secretion of PTH which aims to increase calcium levels
What hormone is released in response to low levels of calcium in the blood?
PTH
Where are the 2 areas of action of PTH?
- Bone
2. Kidneys –> blood vessels
What does PTH do to bone in order to increase calcium levels?
Acts on osteoclasts aiming to increase bone breakdown and release calcium in to the blood
What are the 2 ways PTH acting on the kidneys increase calcium level in the blood?
- Decrease calcium secretion in the urine
2. Activates vitamin D that enhanced absorption of calcium from the intestines
How would calcium and phosphate levels present in a patient suffering from hyperparathyroidism?
Hypocalcaemia
Hyperphosphotaemia
What is primary hyperparathyroidism characterised by?
Issue with the thyroid gland
What are the 3 causes of hyperparathyroisim?
- adenoma
- hyperplasia
- Parathyroid cancer
What account for 80% of primary hyperparathyroidism?
Adenoma
What are the 3 causes of secondary hyperparathyroidism?
- Hypocalcaemia
- Low vitamin D
- Chronic renal failure
What can happen as a result of over compensatory secretion of PTH from the parathyroid gland?
Parathyroid hyperplasia
What causes tertiary hyperparathyroidism?
Prolonged secondary hyperparathyroidism that causes hyperplasia and therefore an increase in baseline PTH
What is malignant hyperparathyroidism caused by?
Parathyroid related protein produced by some cancers (e.g. lung and breast) that mimics PTH and therefore increases calcium levels
How might an EKG of a patient suffering from hyperparathyroidism present and what does it represent?
short QT intervals which is a hallmark for high calcium levels
List 5 symptoms of hyperparathyroidsim?
- depression
- tiredness
- polydipsia and polyuria
- nausea and loss of appetite
- muscle weakness
- constipation
- loss of concentration
- mild confusion
- bone fractures
- renal stones
- dehydration
Why might patients with hyperparathyroidism have bone fractures/osteoporosis?
Due to increase breakdown of bone
Why might patients with hyperparathyroidism have nausea and vomiting?
high levels of calcium increases gastric acid levels
Why might patients with hyperparathyroidism have renal stones?
increased levels of calcium in the kidneys increases the chances of developing renal stones
Like 3 complications of hyperparathyroidism?
- osteoporosis
- kidney stones
- peptic ulcers
- pancreatitis
List 2 serious complications of hyperparathyroidism?
Cardiac arrhythmia
rapid kidney failure
Describe blood results of primary hyperparathyroidism?
PTH- high
Calcium- high
Phosphate- low
Describe blood results of secondary hyperparathyroidism?
PTH- high
calcium- low
phosphate- low
Describe blood results of tertiary hyperparathyroidism?
PTH- high
Calcium- high
Phosphate- high
In primary hyperparathyroidism is PTH response secretion appropriate or inappropriate?
Inappropriate
In secondary hyperparathyroidism is PTH response secretion appropriate or inappropriate?
Appropriate
In tertiary hyperparathyroidism is PTH response secretion appropriate or inappropriate?
Inappropriate
What is the aim of treatment in hyperparathyroidism?
To reduce PTH and calcium levels and keep patient hydrated
What is the name of the surgical procedure that can be used to treat hyperparathyroidism?
Parathyroidectomy
What does a parathyroidectomy involve?
Removal of the enrlarged areas or of the adenoma
