Parathyroid adenoma/hyperparathyroidism Flashcards

1
Q

What is the definition of a parathyroid adenoma/hyperparathyroidism?

A

Benign tumour of the parathyroid gland. Normally causes primary hyperparathyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the pathology of parathyroid adenoma/hyperparathyroidism?

A
  • 4 parathyroid glands situated posterior to the thyroid
  • Release PTH in response to negative feedback via Ca2+ levels
  • PTH causes ↑ osteoclast activity = release Ca2+ and phosphate from bones = ↑ Vit D
  • Parathyroid proliferative disorder
  • Proliferation of chief cells or oxyphilic cells
  • Can be cystic, some nuclear pleomorphism, haemorrhage, inflammatory cells and fibrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the risk factors/aetiology of parathyroid adenoma/hyperparathyroidism?

A
  • Post menopausal woman
  • Ionising radiation?
  • Genetics e.g. MEN (Multiple Endocrine Neoplasia Syndrome)
  • Secondary – kidney failure/Vit D deficiency
  • Tertiary – chronic kidney disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the signs/symptoms of parathyroid adenoma/hyperparathyroidism?

A
  • Most are asymptomatic
  • ‘Bones, stones, abdominal groans and psychic moans’
  • Osteoporosis/osteopenia
  • Renal calculi
  • Muscle weakness/Proximal myopathy
  • Fatigue
  • Anorexia
  • Nausea/vomiting
  • Constipation
  • Abdominal pain
  • Peptic ulcers
  • Acute pancreatitis
  • Polyuria/polydipsia/dehydration
  • Depression/dementia/confusion/memory loss
  • Arrhythmias – severe
  • Coma/death – severe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What diseases present similarly to parathyroid adenoma/hyperparathyroidism?

A
  • Gland hyperplasia – cause of hyperparathyroidism
  • Parathyroid carcinoma – cause of hyperparathyroidism
  • Familial benign hypercalcaemia
  • Lithium induced hypercalcaemia
  • Thyrotoxicosis
  • Sarcoidosis
  • Paget’s disease of the bone
  • Addison’s disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What investigations are conducted for suspected parathyroid adenoma/hyperparathyroidism?

A
  • ↑ PTH
  • ↑ Ca
  • ↓ Phosphate
  • Plasma albumin adjusted calcium levels
  • U&Es
  • Vit D
  • DEXA scan
  • X-Ray – salt and pepper degranulation in the skull, renal calculi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the surgical treatments for parathyroid adenoma/hyperparathyroidism?

A

• Parathyroidectomy – for severely symptomatic patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the pharmacological treatments for parathyroid adenoma/hyperparathyroidism?

A
  • Vitamin D
  • HRT – postmenopausal woman
  • Raloxifene – postmenopausal woman
  • Bisphosphonates
  • Cinacalcet - ↓ both Ca and PTH levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the non pharmacological treatments for parathyroid adenoma/hyperparathyroidism?

A
  • Hydration

* Balanced diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly