parathyroid disease Flashcards
the inferior parathyroid glands arise from the ___and superior from the ___ branchial pouches
3rd; 4th
types of iPTH assays (2)
- IRMA - 2 site assay
2. ICMA - 2 site assay
what are IRMA and ICMA specific to?
intact PTH
target organs of PTH (3)
- bone
- intestinal mucosa
- kidney
where does most Ca absorption happen?
proximal tubule
where does PTH fine tune Ca absorption?
distal tubule
what acid-base balance would you expect in a hyperPTH person?
hyperchloremic metabolic acidosis
if a patient is hypercalcemic, 1st test to check is?
PTH
most common cause of primary hyper parathyroidism
single parathyroid adenoma
primary hyperPTH results in ____serum Ca, ___serum phosphate, ___iPTH, ____urine Ca
incr serum Ca, decr or normal phosphate, incr or normal iPTH, incr urine Ca
what type of bone suffers greater loss of Ca in hyper PTH?
cortical bone (wrist, phalanges, skull)
what is the cure for primary hyper PTH?
surgery
acute hypocalcemia 48 hours after removal of parathyroids is due to?
hungry bones syndrome
vitamin D deficiency or renal failure leads to what type of hyperparathyroidism?
secondary hyperparathyroidism
continuous hyperparathyroidism resulting from chronic renal disease?
tertiary
inactivating mutation in CaR with mild hypercalcemia, normal/elevated iPTH, LOW URINE Ca, asymptomatic
Familial Hypocalciuric Hypercalcemia(FHH)
what differentiates FHH from primary hyperparathyroidism?
urine Ca
surgery recommended for those with serum Ca ____, creatinine clearance___, age___
1 mg/dl upper limits of normal; under 75%; under 50 years
causes of hypo PTH
- decr PTH production
2. resistance to PTH
if patient hypocalcemic, high PTH, causes include (2)
- Vit D deficiency
2. pseudo hypoPTH
tx of hypocalcemia (3)
- IV Ca gluconate
- Vit D3
- synthetic PTH analog (NATPARA)
defect in Gs subunit of PTH receptor on end organ
pseudohypoparathyroidism
pseudohypoparathyroidism has ____Ca, ____P, ____iPTH
low Ca, high P, high iPTH
pseudohypoparathyroidism with short stature, round face, short metacarpals/metatarsals, calcified basal ganglia, and abnormal lab findings
Type 1A Albright’s hereditary osteodystrophy
pseudohypoparathyroidism with lab findings, not not phenotype
pseudohypoparathyroidism type 1B
pseudohypoparathyroidism with short stature, round face, short metacarpals/metatarsals, calcified basal ganglia, BUT no abnormal lab findings
pseudo pseudohypoparathyroidism
