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Parathyroid Disorders Flashcards

1
Q

What is hypocalcaemia

A

Low calcium levels in the blood serum

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2
Q

Causes of hypocalcaemia

A

Chronic kidney disease
(Pseudo)hypoparathyroidism
Autoimmune
Hypomagnesaemia

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3
Q

Symptoms of hypocalcaemia

A

Paraesthesia of the fingers and toes
Muscle cramps and weakness
Fatigue
Fits
Bronchospasm or laryngospasm

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4
Q

Clinical signs of hypocalcaemia

A

Chovesteks sign
Trousseau sign
QT prolongation on ECG

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5
Q

What is chovesteks sign

A

Gentle tapping over the facial nerve causes twitching of the ipsilateral facial muscles

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6
Q

What is trousseau sign

A

Inflation of the BP cuff above systolic pressure for 3 mins induces tetanic spasm of the fingers and wrist

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7
Q

Investigation of hypocalcaemia

A

Low serum calcium

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8
Q

Management of acute severe hypocalcaemia

A

IV calcium gluconate
Calcium infusion

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9
Q

Long term management of hypocalcaemia

A

Supplement
Vitamin D

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10
Q

What is hypomagnesemia

A

Low magnesium levels in the blood serum

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11
Q

Causes of hypomagnesemia

A

Alcohol, drugs, GI illness with diarrhoea, pancreatitis, malabsorption

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12
Q

Name some drugs which can cause hypomagnesemia

A

Thiazide, PPIs

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13
Q

Symptoms of hypomagnesemia

A

Anorexia
N+V
muscle weakness, lethargy
Fits

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14
Q

Clinical signs of hypomagnesemia

A

Cardiac arrhythmia
Positive chovestek sign + trousseau sign indicate secondary hypocalcaemia

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15
Q

Investigations for hypomagnesemia

A

Low serum magnesium
*measure other electrolytes: K+, Ca2+

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16
Q

Management of hypomagnesemia

A

Magnesium supplementation
+ calcium supplements if needed

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17
Q

What is the main complication of hypomagnesemia

A

Secondary hypocalcaemia

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18
Q

What is hypoparathyroidism

A

Condition where the parathyroid glands produce too little parathyroid hormone

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19
Q

Causes of hypoparathyroidism

A

DiGeorge syndrome
Destruction of gland
Autoimmune: Addisons, pernicious anaemia
Hypomagnesemia

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20
Q

What is the result of too little parathyroid hormone being produced

A

Causes blood calcium levels to fall and blood phosphorus levels to rise

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21
Q

Which cells produce parathyroid hormone

A

Chief cells

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22
Q

Clinical presentation of hypoparathyroidism

A

Paraesthesia in fingers, toes and lips
Twitching facial muscles
Tiredness, mood changes
Dry, rough cough
Coarse hair and fingernails that break easily

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23
Q

Biochemistry of hypoparathyroidism

A

Low PTH
low calcium
High phosphorus

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24
Q

Management of hypoparathyroidism

A

Calcium supplement + vit D

25
What is pseudohypoparathyroidism
Condition associated primarily with resistance to PTH
26
Genetic defect associated with pseudohypoparathyroidism
Dysfunction of Gs alpha subunit (GNAS1 gene)
27
Pathophysiology of pseudohypoparathyroidism
End organ resistance to PTH due to mutation of Gsa protein which is coupled to the PTH receptor
28
Clinical presentation of pseudohypoparathyroidism
Bone abnormalities Obesity Subcutaneous calcification Learning disability Brachydactyly
29
What is brachydactyly
Shortened fingers and toes
30
Blood results in pseudohypoparathyroidism
Low calcium Elevated PTH due to resistance
31
What is pseudo-pseudohypoparathyroidism
Patient has the features of pseudohypoparathyroidism but normal blood calcium and phosphate levels
32
What is hyperparathyroidism
Overactivity if the parathyroid glands with high levels of PTH
33
What causes primary hyperparathyroidism
Tumour of the parathyroid gland
34
Management of primary hyperparathyroidism
Removal of the tumour
35
What causes secondary hyperparathyroidism
Low vitamin D or chronic kidney disease
36
What causes tertiary hyperparathyroidism
Occurs when secondary continues for a long time leading to hyperplasia of the glands
37
Blood results in primary hyperparathyroidism
High PTH high calcium
38
Bloods in secondary hyperparathyroidism
High PTH low or normal calcium
39
Bloods in tertiary hyperparathyroidism
High PTH High calcium
40
Roles of PTH (4)
Activates osteoclasts Increases reabsorption of calcium by renal tubules Increases urinary phosphate excretion Increased synthesis of active forms of vit D
41
How is PTH production usually regulated
It’s functions increase serum calcium which inhibits PTH secretion
42
What is a complication of unchecked hyperparathyroidism
Fibrosa cystica
43
Clinical features of fibrosa cystica
Osteoporosis Brown tumours Osteitis
44
How can brown tumours present on investigation
Lytic lesion on x-ray
45
Management of secondary hyperparathyroidism
Correcting vitamin D deficiency Renal transplant to treat failure
46
Management of tertiary hyperparathyroidism
Surgical removal of the part of the parathyroid tissue
47
Indications for parathyroidectomy
End organ damage Very high calcium Under the age of 50
48
What is hypercalcaemia
High calcium levels in the blood serum
49
Name some causes of hypercalcaemia
Primary or tertiary hyperparathyroidism Malignancy Genetic syndromes Drugs Granulomatous disease
50
Name some genetic syndromes which can cause hypercalcaemia
MEN1 + 2 Familial isolated hyperparathyroidism Familial hypocalciuric hypercalcaemia
51
What is Familial hypocalciuric hypercalcaemia
Autosomal dominant deactivating mutation in the calcium sensing receptor which decreases the sensitivity
52
Name some drugs which can cause hypercalcaemia
Vit D, thiazide
53
Clinical presentation of hypercalcaemia
Stones, bones, groans and psychiatric moans
54
symptoms of acute hypercalcaemia
Thirst, dehydration, polyuria Confusion
55
What is polyuria
Excessive production of urine
56
Symptoms of chronic hypercalcaemia
Myopathy Fractures Osteopenia Depression Hypertension
57
Biochemistry of hypercalcaemia
Raised calcium Serum ALP raised in malignancy Serum PTH raised in hyperparathyroidism
58
Investigations of Familial hypocalciuric hypercalcaemia
Bloods: mild hypercalcaemia, reduced urine calcium excretion, PTH may be marginally elevated Genetic screen
59
Management of acute severe hypercalcaemia
Rehydrate with 0.9% saline Consider loop diuretics once rehydrated Bisphosphonates

endocrine (15 decks)

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