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Gen Surg (Breast and Thyroid) > Parathyroid & Calcium Metabolism > Flashcards

Parathyroid & Calcium Metabolism Flashcards

1
Q

What is the overall effect of parathyroid hormone?

A

To increase serum calcium and decrease serum phosphate

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2
Q

What effect does PTH have on bone?

A

Increases bone turnover, by increasing osteoclast activity

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3
Q

What effect does PTH have on reabsorption in the kidneys?

A

Increases reabsorption of calcium, decreases reabsorption of phosphate

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4
Q

PTH increases the production of what in the kidneys?

A

Calcitriol (1, 25-dihydroxy-vitamin D3)

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5
Q

What is the effect of calcitriol (1, 25- dihydroxy-vitamin D3)?

A

Increases calcium absorption from the gut

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6
Q

What triggers the secretion of PTH from the parathyroid gland?

A

Low serum calcium levels

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7
Q

What effect does a low serum calcium have on PTH levels?

A

Increased

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8
Q

What effect does a high serum calcium have on PTH levels?

A

Decreased

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9
Q

What other substance plays a synergistic role with PTH by increased calcium reabsorption from the kidneys and increasing bone turnover, but at a much slower rate?

A

Vitamin D3

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10
Q

Where is calcitonin produced?

A

The parafollicular ‘C’ cells of the thyroid gland

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11
Q

What is the effect of calcitonin?

A

Decrease serum calcium and phosphate

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12
Q

What electrolyte is required in order to allow PTH release from the parathyroid glands?

A

Magnesium

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13
Q

How are the features of hypercalcaemia typically remembered?

A

Bones, stones, groans and psychic moans

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14
Q

What are some gastrointestinal features of hypercalcaemia?

A

Abdominal pain, vomiting, constipation, peptic ulcers

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15
Q

What are some renal/urological features of hypercalcaemia?

A

Polyuria, polydipsia, renal stones

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16
Q

What effect does hypercalcaemia have on bones, clinically?

A

Osteopenia/osteoporosis, and increased risk of fractures

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17
Q

Patients with hypercalcaemia should always undergo what investigation to screen for osteoporosis?

A

DEXA bone scan

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18
Q

What ECG change may be seen in individuals with hypercalcaemia?

A

Shortened QT interval

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19
Q

What are the three causes of primary hyperparathyroidism?

A

Parathyroid adenoma (85%), parathyroid hyperplasia (15%), parathyroid carcinoma (< 1%)

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20
Q

What are the three main causes of hypercalcaemia of malignancy?

A

Bony metastases, myeloma, ectopic production of PTH related peptide

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21
Q

What are some malignancies which may result in the release of PTH related protein?

A

Squamous cell lung cancer, breast carcinoma, renal cell carcinoma

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22
Q

What will the levels of PTH and calcium be in individuals with malignant hyperparathyroidism?

A

High calcium, low PTH (because PTH related protein doesn’t show up on the assay)

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23
Q

When is acute treatment required for hypercalcaemia?

A

If calcium is > 3.5mmol/L or the patient is symptomatic

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24
Q

What are the two main steps in the acute treatment of hypercalcaemia?

A

Rehydration and bisphosphonates

25
Q

How are patients with hypercalcaemia rehydrated?

A

4-6L of IV 0.9% saline are given over 24 hours

26
Q

What happens to phosphate levels in primary hyperparathyroidism?

A

Low

27
Q

What happens to ALP levels in primary hyperparathyroidism?

A

High

28
Q

Secondary hyperparathyroidism is a reactive increase in PTH production to compensate for hypocalcaemia. This is usually caused by one of what two things?

A

Chronic renal failure or vitamin D deficiency (osteomalacia)

29
Q

How should secondary hyperparathyroidism be treated?

A

Treat the underlying cause, give phosphate binders and vitamin D supplements

30
Q

For tertiary hyperparathyroidism to occur, hypersecretion of PTH for many years due to secondary hyperparathyroidism leads to the development of what?

A

Parathyroid hyperplasia

31
Q

What is some advice that can be given to patients with primary hyperparathyroidism if their case is mild or if surgery needs to be avoided?

A

Drink plenty fluids, avoid a high calcium/vitamin D intake, avoid thiazide diuretics

32
Q

If there is no obvious cause for hypercalcaemia then the underlying cause is most likely to be what?

A

Primary hyperparathyroidism

33
Q

What happens to PTH and calcium levels in primary hyperparathyroidism?

A

PTH high, calcium high

34
Q

What happens to PTH and calcium levels in secondary hyperparathyroidism?

A

PTH high, calcium low

35
Q

What happens to PTH and calcium levels in tertiary hyperparathyroidism?

A

PTH high, calcium high

36
Q

What are some drugs which may cause a high PTH and high calcium?

A

Lithium and thiazide diuretics

37
Q

What is the management option of choice for primary hyperparathyroidism?

A

Surgery

38
Q

What is the surgical management of choice for a parathyroid adenoma?

A

Parathyroidectomy of the affected gland

39
Q

What is the surgical management of choice for parathyroid hyperplasia?

A

Parathyroidectomy of all four glands, one gland is transplanted into the forearm

40
Q

Calcium levels should be monitored for how long after a parathyroidectomy?

A

14 days or more

41
Q

Parathyroid hyperplasia may occur as part of which two MEN syndromes?

A

MEN1 and MEN2A

42
Q

How is familial hypocalciuric hypercalcaemia inherited?

A

Autosomal dominant

43
Q

What is the most common feature of hypocalcaemia?

A

Paraesthesia (fingers, toes, peri-oral)

44
Q

What ECG change may be seen with hypocalcaemia?

A

Prolonged QT interval

45
Q

Chvostek’s sign is seen individuals with hypocalcaemia. Describe this sign?

A

Tapping over the parotid gland causes facial muscles to twitch

46
Q

Trousseau’s sign is seen in individuals with hypocalcaemia. Describe this sign?

A

Fingers draw together and wrist flexion occurs on inflation of a BP cuff

47
Q

A deficiency of what electrolyte can cause secondary hypoparathyroidism and hence hypocalcaemia?

A

Magnesium

48
Q

How is hypocalcaemia managed in the long term?

A

Oral calcium and vitamin D supplements

49
Q

What is the emergency treatment for hypocalcaemia?

A

10mls 10% calcium gluconate over 10 mins in 50ml saline or dextrose

50
Q

What are the two main causes of primary hypoparathyroidism?

A

Autoimmune or congenital

51
Q

Other than hypomagnesaemia, what are some potential causes of secondary hypoparathyroidism?

A

Radiation or surgery to the thyroid/parathyroid gland

52
Q

What happens in pseudohypoparathyroidism?

A

There is failure of the target cells to respond to PTH

53
Q

Short 4th + 5th metacarpals, a round face, short stature, calcified basal ganglia and low IQ are signs of what condition?

A

Pseudohypoparathyroidism

54
Q

What happens to PTH and calcium levels in primary hypoparathyroidism?

A

Low PTH, low calcium

55
Q

What happens to PTH and calcium levels in secondary hypoparathyroidism?

A

Low PTH, low calcium

56
Q

What happens to PTH and calcium levels in pseudohypoparathyroidism?

A

High PTH, low calcium

57
Q

What happens to PTH and calcium levels in pseudopseudohypoparathyroidism?

A

Both normal

58
Q

What is pseudopseudohypoparathyroidism?

A

The morphological features of pseudohypoparathyroidism but with normal biochemistry

59
Q

What is the cause for both pseudo and pseudopseudo hypoparathyroidism?

A

Genetic

Gen Surg (Breast and Thyroid) (8 decks)

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