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Endocrine > Parathyroid Disease > Flashcards

Parathyroid Disease Flashcards

1
Q

What are the two major anatomical variations that can occur with the inferior parathyroid glands?

A

May sometimes follow the thymus and end up in the superior mediastinum

5th PT gland development

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2
Q

What is the chromosome that has the PTH gene?

A

Chromosome 11

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3
Q

What is the half life of PTH?

A

2-4 minutes

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4
Q

What two organs clear PTH?

A

Liver and kidney

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5
Q

What is significance of the breakdown products of PTH?

A

Fragments are thought to have their own receptors and biological activity

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6
Q

What are the modern iPTH assays useful for?

A

Assaying for the intact PTH

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7
Q

True or false: modern iPTH assays are able to detect both high and low levels of iPTH

A

True

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8
Q

Where are CaR receptors found?

A

Ubiquitous

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9
Q

What, besides [Ca] cause secretion of PTH? (3)

A

Mg
Vit D
Catecholamines

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10
Q

What is the effect of PTH on the proximal tubule? Distal?

A

Proximal = Decreases phosphate reabsorption

Distal = increases Ca reuptake

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11
Q

Where is most of the Ca in the renal tubules reabsorbed? What is the role of PTH in this?

A

Most reabsorbed in the proximal tubule, which is NOT affected by PTH

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12
Q

Where does PTH act in the kidney (proximal or distal tubule)?

A

Distal

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13
Q

Most Ca reabsorption in the kidney occurs where? Is this regulated? What about the fine tuning of Ca? What is this usually brought in with?

A

Proximal tubule where most occurs (and is not regulated), but fine tuning in the distal nephron

H2CO3 + Na

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14
Q

What is the effect of PTH in the proximal tubule of the kidney in terms of phosphate reabsorption?

A

Inhibits phosphate

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15
Q

What type of metabolic disturbance (acidosis/alkalosis) can occur with abnormally elevated PTH levels?

A

Hyperchloremic metabolic acidosis

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16
Q

What are the three main causes of decreased PTH hormone?

A
  • Hypoparathyroidism
  • Hypercalcemia of malignancy
  • Hypomagnesemia
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17
Q

What is the most common cause of increased PTH levels in ambulatory patients?

A

Hyperparathyroidism

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18
Q

What is the most common cause of increased PTH levels in hospitalized patients?

A

Malignancy

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19
Q

What is the first line test for a hypercalcemic patient?

A

PTH levels

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20
Q

What are the components of the VITAMINS TRAP mnemonic for hypercalcemia (just vitamins bit)?

A
  • Vits A and D xs
  • Immobilization
  • Thyrotoxicosis
  • Addison’s ds
  • Milk-alkali/metastatic ds
  • Inflammatory ds
  • Sarcoid
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21
Q

What are the components of the VITAMINS TRAP mnemonic for hypercalcemia (just TRAP bit)?

A
  • Thiazides
  • Rhabdo
  • AIDS
  • Paget’s ds
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22
Q

What type of diuretics may cause hypercalcemia?

A

Thiazide diuretics

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23
Q

Which gender more commonly gets primary hyperPTH? What is the most common cause of this?

A

Female

Single PTH adenoma

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24
Q

What genetic disease may lead to primary parathyroid adenomas?

A

MEN2A/2B

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25
Q

What happens to [Ca] with primary hyperPTH? [Phosphate]? [iPTH]? Urine [Ca]?

A
  • Increased serum [Ca]
  • Decreased or = serum [phosphate]
  • Increased PTH
  • Increased urine Ca
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26
Q

What are the classical x-ray findings of hyperparathyroidism (hands, skull)?

A

Loss of cortical bones (wrists much greater than hip/spine on DXA scan)

Salt and pepper skull

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27
Q

What is the cure for primary hyperPTH?

A

Surgical

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28
Q

True or false: it is necessary to look at ALL parathyroid glands if there is hyperPTH

A

True

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29
Q

What is the treatment for PT hyperplasia?

A

Subtotal parathyroidectomy, leaving 50 mg of PT tissue in situ OR in forearm

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30
Q

What is Hungry bone syndrome?

A

In pts treated for severe PTH bone disease, the bones mop up Ca as the parathyroid drive ceases

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31
Q

How do you monitor for a loss of a parathyroid gland during surgery? What should this show if you excised the right gland?

A

Intraoperative PTH

More than 50% drop

32
Q

What is the medical therapy for primary hyperPTH? (3)

A
  • Avoid diuretics
  • Hydrate
  • Calcimimetics
33
Q

Why is estrogen not used for treating hyperPTH?

A

Side effects

34
Q

What is the role of bisphosphonates in the medical therapy of hyperPTH?

A

Decrease bone turnover

35
Q

How often should you monitor pts with primary PTH pts undergoing medical therapy? What should be measured?

A

6 months

-Serum [Ca], DXA scans

36
Q

What are the two major secondary causes of hyperPTHism?

A
  • Vit D deficiency

- Renal failure

37
Q

What is familial hypocalciuric hypercalcemia?

A

Inactivating mutation in Ca sensor/receptor in the kidney/parathyroids, leading to mild hypercalcemia and normal to elevated iPTH

38
Q

What is the treatment for asymptomatic familial hypocalciuric hypercalcemia?

A

nothing

39
Q

How do you differentiate familial hypocalciuric hypercalcemia from hyperparathyroidism?

A

Familial will have normal urine Ca levels

40
Q

What are the two general causes of hypoPTH?

A

Decrease production or response

41
Q

What are the causes of hypoPTH?

A
  • Surgical complications
  • Infiltrative ds
  • Autoimmune destruction
42
Q

What is the autoimmune ds that can lead to hypoPTH?

A

AI Polyglandular syndrome type 1

43
Q

What congenital syndrome may cause hypoPTHism?

A

DiGeorge syndrome

44
Q

What metabolic disturbance can cause hypoparathyroidism?

A

Hypomagnesemia

45
Q

What do the ssx of hypoparathyroidism depend on?

A

Degree and rapidity of onset of hypocalcemia

46
Q

What are the acute ssx of hypoparathyroidism? Chronic?

A
  • Acute = Paresthesias, Tetany

- Chronic = Apathy/depression

47
Q

What are the brain CT findings with hypoparathyroidism?

A

Calcification of basal ganglia and benign intracranial HTN

48
Q

What are the GI ssx of hypoparathyroidism?

A

Nausea/vomiting/ abdo pain

49
Q

What are the EKG findings of hypocalcemia?

A

Prolonged QT

50
Q

What are the eye effects of hypoparathyroidism?

A

Cataracts

51
Q

What other diseases can mimic hypoparathyroidism

A
  • Vit D resistance
  • Malabsorption
  • Decrease Ca mobilization from bone 2/2 metastatic ds
52
Q

What GI organ complication can cause hypocalcemia?

A

pancreatitis

53
Q

What hematological disturbance can cause a hypocalcemia?

A

albumin

54
Q

What other ion should be measured with hypocalcemia?

A

Mg

55
Q

A decrease in 25 vit D3 indicates what organ pathology?

A

Liver

56
Q

A decrease in 1, 25 vit D3 indicates what organ pathology?

A

Kidney

57
Q

How do you correct Ca levels with low albumin?

A

Nl [Alb] - pts [alb]x0.8 + [Ca]

58
Q

What is the treatment for hypocalcemia?

A
  • IV Ca gluconate

- Vit D3

59
Q

Who should be treated for hypocalcemia?

A

If symptomatic or has complications

60
Q

What is the new drug for treating hypocalcemia? How is this administered?

A

NATPARA (synthetic PTH analog)

SQ QD

61
Q

What is the role of NATPARA in treating hypocalcemia?

A

Reduces the dose of Vit D and Ca needed

62
Q

True or false: NATPARA decreases the risk of renal calculi

A

True

63
Q

What is pseudohypoparathyroidism types 1A and 1B?

A

End organ resistance to PTH d/t defects in the Gs subunits

64
Q

What are the lab findings of pseudohypoparathyroidism types 1A and 1B? (Ca, phosphate, PTH)

A
  • Hypocalcemia
  • Hyperphosphatemia
  • High iPTH
65
Q

What is Albright’s hereditary osteodystrophy pseudohypoparathyroidism type 1 A? SSx?

A

Type 1 pseudohypoparathyroidism that causes:

  • short stature
  • short metacarpals
  • Calcified basal ganglia
  • mild mental subnormality
66
Q

What are the characteristic hand findings of Albright’s hereditary osteodystrophy?

A
  • Dimples over the MCPs
  • Brachydactyly of the hand
  • Short, wide thumb
67
Q

What is the difference between pseudohypoparathyroidism types 1A and 1B?

A

Same, but no physical findings with 1b

68
Q

What is pseudo-pseudohypoparathyroidism?

A

Same phenotype of pseudohypoparathyroidism type 1A, but NO biochemical abnormalities

69
Q

What causes the super high PTH levels in pseudohypoparathyroidism?

A

Resistance to PTH, NOT deficiency

70
Q

Salt and pepper skull is seen in what disease?

A

Primary hyperparathyroidism

71
Q

What is the treatment for parathyroid hyperplasia?

A

Remove 3.5 glands

72
Q

True or false: if a patient is symptomatic from primary hyperparathyroidism, you have to do surgery

A

True

73
Q

What is the CrCl level that indicated the need for surgery with primary hyperparathyroidism? What other renal symptom indicates the need for surgery?

A

Less than 70%, OR have a h/o stone

74
Q

What is the serum [Ca] level that indicated the need for surgery with primary hyperparathyroidism?

A

More than 1 mg/dL above the normal limits

75
Q

What is the bone mineral density T score that indicated the need for surgery with primary hyperparathyroidism? What bone(s) must this be?

A

Less than 2.5 SD at ANY site

76
Q

What is the age that indicated the need for surgery with primary hyperparathyroidism?

A

Less than 50 y.o.

77
Q

What is tertiary hyperparathyroidism?

A

Continuous parathyroid stimulation in secondary leads to an autonomous parathyroid gland

Endocrine (32 decks)

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