parathyroid disease

Question 1

the inferior parathyroid glands arise from the ___and superior from the ___ branchial pouches

Answer 1

3rd; 4th

Question 2

types of iPTH assays (2)

Answer 2

1. IRMA - 2 site assay

2. ICMA - 2 site assay

Question 3

what are IRMA and ICMA specific to?

Answer 3

intact PTH

Question 4

target organs of PTH (3)

Answer 4

1. bone
2. intestinal mucosa
3. kidney

Question 5

where does most Ca absorption happen?

Answer 5

proximal tubule

Question 6

where does PTH fine tune Ca absorption?

Answer 6

distal tubule

Question 7

what acid-base balance would you expect in a hyperPTH person?

Answer 7

hyperchloremic metabolic acidosis

Question 8

if a patient is hypercalcemic, 1st test to check is?

Answer 8

PTH

Question 9

most common cause of primary hyper parathyroidism

Answer 9

single parathyroid adenoma

Question 10

primary hyperPTH results in ____serum Ca, ___serum phosphate, ___iPTH, ____urine Ca

Answer 10

incr serum Ca, decr or normal phosphate, incr or normal iPTH, incr urine Ca

Question 11

what type of bone suffers greater loss of Ca in hyper PTH?

Answer 11

cortical bone (wrist, phalanges, skull)

Question 12

what is the cure for primary hyper PTH?

Answer 12

surgery

Question 13

acute hypocalcemia 48 hours after removal of parathyroids is due to?

Answer 13

hungry bones syndrome

Question 14

vitamin D deficiency or renal failure leads to what type of hyperparathyroidism?

Answer 14

secondary hyperparathyroidism

Question 15

continuous hyperparathyroidism resulting from chronic renal disease?

Answer 15

tertiary

Question 16

inactivating mutation in CaR with mild hypercalcemia, normal/elevated iPTH, LOW URINE Ca, asymptomatic

Answer 16

Familial Hypocalciuric Hypercalcemia(FHH)

Question 17

what differentiates FHH from primary hyperparathyroidism?

Answer 17

urine Ca

Question 18

surgery recommended for those with serum Ca ____, creatinine clearance___, age___

Answer 18

1 mg/dl upper limits of normal; under 75%; under 50 years

Question 19

causes of hypo PTH

Answer 19

1. decr PTH production

2. resistance to PTH

Question 20

if patient hypocalcemic, high PTH, causes include (2)

Answer 20

1. Vit D deficiency

2. pseudo hypoPTH

Question 21

tx of hypocalcemia (3)

Answer 21

1. IV Ca gluconate
2. Vit D3
3. synthetic PTH analog (NATPARA)

Question 22

defect in Gs subunit of PTH receptor on end organ

Answer 22

pseudohypoparathyroidism

Question 23

pseudohypoparathyroidism has ____Ca, ____P, ____iPTH

Answer 23

low Ca, high P, high iPTH

Question 24

pseudohypoparathyroidism with short stature, round face, short metacarpals/metatarsals, calcified basal ganglia, and abnormal lab findings

Answer 24

Type 1A Albright’s hereditary osteodystrophy

Question 25

pseudohypoparathyroidism with lab findings, not not phenotype

Answer 25

pseudohypoparathyroidism type 1B

Question 26

pseudohypoparathyroidism with short stature, round face, short metacarpals/metatarsals, calcified basal ganglia, BUT no abnormal lab findings

Answer 26

pseudo pseudohypoparathyroidism