Parathyroid Diseases

Question 1

Nephrolethiasis ( renal stones ) can be caused by hypo or hyper-parathyroidism ?

Answer 1

Primary Hyper-parsthyroidism causes hyoercalciuria ➡️ stones

Question 2

Note: from which part of the intestine the calcium is absorbed?

Answer 2

Duodenum

Question 3

Note: what’s the only disease that can cause hypercalcemia at the same time hypocalciuria?

Answer 3

Familial hypocalciruric hypercalcemia ( because of loss of function of gene caSR )

Question 4

Note: what do you expect to see on ECG for ptn with hypercalcemia?

Answer 4

Short Q-T

Question 5

Note: how to treat or lower hypercalcemia?

Answer 5

• IV normal saline + loop diuretic+ IV bisphosphonate ( zoledronate,pamidronate ) ⬇️Osteoclasts and ⬆️ osteoblasts
• +/- calcitonin ( for rapid decrease by ⬇️ Osteoclasts)

Question 6

Note: what’s the association b/w Alkalosis and hypocalcemia?

Answer 6

In Alkalosis the free calcium will bind to Albumin while in acidosis the hydrogen Ion will bind to albumin leaving the calcium free ➡️ hypercalcemia

Question 7

Note: what’s the best way to localize parathyroid adenoma?

Answer 7

A neuclear parathyroid scan (sestamibi ) + neck sonogram for accurate and clear results

Question 8

Note: what’s Chvostek sign and where can you see it?

Answer 8

It’s a percussion of the facial nerve in front of the ear which cause a contraction of the facial muscles and upper lip, it’s seen in ptn with hypoparathyroidism ( hypocalcemia )

Question 9

Note: what’s Trousseau sign and where it’s seen?

Answer 9

By inflation of blood pressure cuff on the arm to a pressure higher than the ptn’s systolic pressure for 3 min. Will cause flexion of the metacarpophalangeal joints and extension of the interphalangeal joints, seen in ptn with hypoparathyroidism ( hypocalcemia )

Question 10

Note: what the association between high or low phosphorus level with hypocalcemia?

Answer 10

1Low calcium with high phosphorus = renal failure or massive tissue destruction or hypoparathyroidism

Low calcium with low phosphorus = absent or ineffective Vit. D

Question 11

N. Ptn presents with sq. Cell lung carcinoma with hypercalcemia. What’s the test done to evaluate hypercalcemia of malignancy?

Answer 11

PTHrP ( parathyroid hormone related peptide)

Question 12

What’s the most common cause of hypercalcemia other than parathyroid related diseases?

Answer 12

Malignancy ass. Hypercalcemia ( lung, breast, kidney ) calcium >14mg/dl ( sever )

Question 13

N. How to manage ptn with hypercalcemia that is >12?

Answer 13

Aggressive hydration/ No diuretics ( unless there’s kidney or heart failure) / subcutaneous calcitonin/ bisphosphonates ( only after checking renal function) / glucocorticoids/ restriction of calcium & vitamin D intake / hemodialysis

Question 14

N. What do you expect the phosphorus level to be in vitamin D dependent hypercalcemia ?

Answer 14

Normal to High ( because Vit D help to ⬆️ phosphorus absorption) also it decreased PTH ➡️ decrease phosphorus excretion

Question 15

Name 3 drugs that cases hypercalcemia ?

Answer 15

Thiazides diuretics( non PTH mediated) ,lithium ( PTH mediated ) ,vitamin D

Question 16

N. What are the 2 famous signs of sever hypocalcemia (<7.5) ?

Answer 16

Trousseau sign ( flexion of metacarpophalenges with extension of interphalenges ) / chovsteck sign ( percussion on the area in front of the ear ➡️ facial nerve spasm )