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Endocrinology > Parathyroid > Flashcards

Parathyroid Flashcards

1
Q

Where is the parathyroid gland located?

A

4 glands located posterior to the thyroid gland

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2
Q

What does the parathyroid gland produce?

A

Parathyroid hormone (PTH)

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3
Q

PTH is the primary regulator of what?

A

Calcium Physiology

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4
Q

PTH directly acts on what?

A
  • Bone: stimulates Ca2+ release
  • Kidneys: enhances Ca2+ reabsorption in the proximal and distal tubules and synthesizes 1, 25 dihydroxyvitamin D- a hormone
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5
Q

PTH indirectly acts on what?

A

GI tract: increases Ca2+ reabsoprtion

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6
Q

Serum PTH levels are tightly regulated by what?

A

Negative feedback loop

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7
Q

In the negative feedback loop calcium is acting on what receptor?

A

Calcium-sensing receptor (CaR) located on the chief cells of the parathyroid glands

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8
Q

In the negative feedback loop Vitamin D is acting on what receptor?

A

Nuclear receptor

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9
Q

High levels of Calcium and Vitamin D reduces what?

A

PTH release and synthesis

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10
Q

What is the feedback loop for hypocalcemia?

A
  • Parathyroid gland: detects low Ca2+
  • Increased PTH release
  • Increases rate of dissolution of bone material and increases Ca2+
  • Reduced renal clearance of Ca2+
  • Increases Ca2+ reabsorption in GI tract
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11
Q

What is the feedback loop for hypercalcemia?

A
  • Parathyroid gland: detects high Ca2+
  • Decreased PTH release
  • Decreases rate of dissolution of bone material and decreases Ca2+
  • Increased renal clearance of Ca2+
  • Decreases Ca2+ reabsorption in GI tract
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12
Q

Hyperparathyroidism is a disorder of what?

A
  • Calcium
  • Phosphate
  • Bone metabolism
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13
Q

What is increased in Hyperparathyroidism? and what does that lead to?

A
  • PTH

- Leads to Hypercalcemia and Hypophosphatemia

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14
Q

More than half the pts that are diagnosed with Hyperparathyroidism are what?

A

Asymptomatic

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15
Q

What are some causes of Hyperparathyroidism?

A
  • Benign Neoplasm or Adenoma Secreting PTH
  • Carcinoma or Parathyroid Hyperplasia (Very Rare)
  • MEN: Multiple Endocrine Neoplasm
  • Lithium Therapy
  • Familial Hypocalciuric Hypercalcemia (FHH)
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16
Q

Hyperparathyroidism manifests primarily in the bones and kidneys, what can that cause?

A
  • Bone: Osteitis Fibrosa Cystica
    (where bone tissue becomes soft and deformed, can be painful)
  • Kidney: Nephrocalcinosis or Recurrent Nephrolithiasis
17
Q

What are the clinical presentations of Hyperparathyroidism?

A
  • Thirst
  • Anorexia/wt loss
  • N/V
  • Abdominal pain
  • Peptic Ulcer
  • Pancreatitis
  • Constipation
  • Fatigue
  • Anemia
  • HTN
  • Depressed reflexes
18
Q

Summary of sxs of Hyperparathyroidism can be remembered by STONES, BONES, GROANS, and MOANS, what does each represent?

A

STONES - Renal: Loss of Calcium & Phosphate

BONES: Pain- Diffuse Bone Demineralization, Trabecular Bone Increase

GROANS: Increased GI Absorption & Abdominal Cramps

MOANS: Irritability & Depression

19
Q

What are the CMP diagnostic findings for Hyperparathyroidism?

A
  • Ca2+: ↑ (2 measurements required to confirm)

- Phosphate: Normal to ↓

20
Q

What are the PTH diagnostic findings for Hyperparathyroidism?

A

↑PTH

If low, when calcium is high, possible malignancy

21
Q

What are the ECG diagnostic findings for Hyperparathyroidism?

A
  • Prolonged PR Interval
  • Shortened QT Interval
  • Bradycardia or Heart Block
22
Q

What are the 24 Hr. Urine Calcium and Creatinine diagnostic findings for Hyperparathyroidism?

A
  • Calcium is ↓ for the degree of hypercalcemia

- Creat. Clearance to assess the kidney functions

23
Q

What are the bone density diagnostic findings for Hyperparathyroidism?

A

Osteopenia or Osteoporosis

24
Q

What is the MCC of acquired hypoparathyroidism?

A

Parathyroidectomy

25
Q

Aside from the MCC what are the other causes of hypoparathyroidism?

A
  • Autoimmune Disease
  • Thyroiditis
  • Hypomagnesemia (Chronic Alcoholic)
  • Heavy Metal Toxicity (Wilson Disease, Hemochromatosis)
26
Q

A common clinical presentations of hypoparathyroidism is hypoclacemia, what are 2 signs used to confirm hypocalcemia?

A
  • Chvostek’s Sign: Tapping on the facial nerve causes contraction of eye, mouth, or nose muscles
  • Trousseau Sign: Inflated BP cuff causes a hand & wrist spasm
27
Q

What are some physical presentations of hypoparathyroidism?

A
  • Pruritus
  • SOB
  • Dry skin/birttle Nails
  • Irritability
  • Dementia/Confusion
  • MS cramping
  • Paresthesias in extremities
  • Hyperactive DTR
  • Seziues
28
Q

What are some cardiovascular sxs caused by hypoparathyroidism?

A
  • Wheezing
  • Crackles
  • Bradycardia
  • Syncope/Angina
29
Q

What are the serum diagnostic findings for hypoparathyroidism?

A
  • PTH: ↓
  • Adjusted Serum Calcium: ↓
  • Phosphate: ↑
  • Magnesium: May be ↓ (Hypomagnesemia may worsen symptoms)
30
Q

What are the ECG diagnostic findings for hypoparathyroidism?

A
  • Prolonged QT Intervals

- T-Wave Abnormalities

31
Q

What are the radiography diagnostic findings for hypoparathyroidism?

A

Chronic Increased Bone Density

esp. lumbar spine and skull

32
Q

What is Pseudohypoparathyroidism?

A

A Group of Distinct Inherited Disorders

33
Q

Pts who have Pseudohypoparathyroidism (PHP-Ia) present with what?

A
  • Hypocalcemia: distinctive skeletal & developmental defects
  • Hyperphosphatemia
  • Increased PTH
34
Q

In Pseudohypoparathyroidism hypocalcemia occurs d/t what?

A

D/t a Deficient Response to PTH

35
Q

What is the clinical presentation of Pseudohypoparathyroidism (PHP-Ia)?

A
  • Short Stature
  • Rounded Face
  • Shortened 4th & 5th MCP
  • Obesity
  • Dental Hypoplasia
  • Soft-Tissue Calcifications or Ossifications
  • Developmentally Delayed
36
Q

What is the PE findings of Pseudohypoparathyroidism (PHP-Ia)?

A
  • Signs of Hypocalcemia
  • Positive Chvostek’s Sign and/or Trousseau Sign
  • Occasionally Cataracts or Papilledema
37
Q

What are the diagnostic studied used to dx Pseudohypoparathyroidism (PHP-Ia)?

A
  • Calcium: ↓
  • Phosphate: ↑
  • Refer to endocrinologist

Endocrinology (18 decks)

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