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ENDOCRINE > PARATHYROID DISORDERS > Flashcards

PARATHYROID DISORDERS Flashcards

1
Q

what are adequate calcium levels in the body dependent on?

A

diet

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2
Q

where is most calcium stored?

A

the bones and teeth

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3
Q

how is plasma calcium broken down?

broken down into what categories?

A
  1. 45% free ionized form (majority)
  2. 40% bound to protein (albumin)
  3. 15% complexed with anions (citrate, phosphate)
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4
Q

what are the functions of calcium?

five things

A
  1. build & maintain strong bones and teeth
  2. smooth muscle contraction
  3. cofactor for enzymatic reactions
  4. regulation of clotting mechanisms
  5. cardiac and nerve function
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5
Q

what are parathyroid glands and where are they?

A

they are 4 pea-sized glands located posterior to the thyroid gland (superior pair and inferior pair)

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6
Q

what do chief cells do?

A

they synthesize, secrete, and store parathyroid hormone (PTH)

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7
Q

what does parathyroid hormone regulate?

A

calcium levels in the blood through calcium sensing receptors within the chief cells

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8
Q

what are the 2 parathyroid disorders and how do they relate to calcium?

A
  1. hyperparathyroidism -> hypercalcemia
  2. hypoparathyroidism -> hypocalcemia
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9
Q

what are the 3 functions of the parathyroid hormone?

A
  1. increases calcium and phosphate release from bones through osteoclast activation
  2. increases calcium reabsorption and phosphate excretion in the distal tubule of the kidney
  3. increase synthesis of 1,35-dihydroxyvitamin D (active vitamin D), which will increase calcium absorption from the GI tract
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10
Q

what is secretion of parathyroid hormone stimulated by?

four things

A
  1. decrease in serum calcium
  2. low levels of 1,25 dihydroxyvitamin D (Active vitamin D)
  3. hyperphosphatemia
  4. hypomagnesmia
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11
Q

what kind of relationship does calcium have to vitamin D?

A

a direct relationship!
(calcium drops? vitamin D drops too. )

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12
Q

what kind of relationship does calcium have to phosphorous?

A

inverse relationship!

as phosphorus levels increase, the levels of free calcium in blood decreases, because phosphorus binds to calcium

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13
Q

what kind of relationship does calcium have to magnesium?

A

direct relationship!
calcium up? mag up too! they besties

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14
Q

what is secretion of PTH inhibited by?

A

high levels of serum calcium

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15
Q

what hormone is produced by the parafollicular cells (c cells) of the thyroid gland?

A

calcitonin

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16
Q

what is secretion of calcitonin stimulated by?

A

increase in serum calcium

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17
Q

what are the 2 functions of calcitonin?

A
  1. inhibits (blocks) activity of osteoclasts (no calcium is released from bone)
  2. decreases calcium reabsorption in kidneys
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18
Q

what is hyperparathyroidism?

A

conditions resulting from increased function of parathyroid glands with overproduction of parathyroid hormone leading to hypercalcemia

  • often discovered incidentally when assessing labs
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19
Q

what is the epidemiology of hyperparathyroidism?

A

women>men
incidence increases after 50 y/o

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20
Q

what are the types of hyperparathyroidism?

A
  1. primary- inherent dz of parathyroid glans
  2. secondary
  3. tertiary
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21
Q

what is the most common type of hyperparathyroidism?

A

PRIMARY hyperparathyroidism

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22
Q

what is going on with PTH and calcium in primary hyperparathyroidism?

A

there are elevated PTH levels independent of calcium levels

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23
Q

how many cases of primary hyperparathyroidism occur sporadically?

A

95%

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24
Q

what is the most likely cause of primary hyperparathyroidism?

A

parathyroid adenoma (benign) -85%

25
Q

what is going on with PTH and calcium in secondary hyperparathyroidism?

A

elevated PTH d/t chronic hypocalcemia

  • not that secondary hyperparathyroidism is d/t an underlying condition that decreases serum calcium levels (abnormal calcium metabolism)
26
Q

what is the most likely cause of secondary hyperparathyroidism?

A

chronic renal failure (CRF)

27
Q

what are some big underlying conditions causing secondary hyperparathyroidism other than CRF?

three

A
  1. bypass surgery d/t reduced surface area for absorption of calcium
  2. celiacs/crohns d/t malabsorption
  3. severe vitamin D deficiency (low dietary intake, lack of sun exposure, or malabsorption)
28
Q

what is the clinical presentation of hyperparathyroidism?

A
  1. bone pain
  2. nephrolithiasis
  3. abdominal cramps and constipation
  4. irritability, confusion, delirium and depression
  5. muscle weakness and rapid muscle fatigue
29
Q

what will you see on an EKG in someone with hyperparathyroidism?

A

short QT interval

30
Q

what is they hyperparathyroidism clinical presentation mnemonic?

A

“stones, bones, abdominal groans, thrones, and psychiatric overtones.”

31
Q

what bone pains will patients with hyperparathyroidism have?

A

there will be bone demineralization (osteoporosis) leading to pathological fractures and cystic bone lesions

32
Q

why will nephrolithiasis occur in hyperparathyroidism?

A

d/t renal loss of calcium (calcium phosphate or calcium oxalate stones)

33
Q

what kind of abdominal pain will occur in patients with hyperparathyroidism?

A

peptic ulcers and pancreatitis

34
Q

what is polyuria and polydipsia related to?

A

hypercalcemia-induced nephrogenic diabetes insipidus

35
Q

what is calciphylaxis?

A

a clinical presentation that a patient with hyperparathyroidism may present with that is deposits of calcium in the skin and muscles

36
Q

what will the labs of a primary hyperparathyroidism patient look like?

A

high serum calcium
low or normal serum phosphorus
high PTH
low urine calcium

37
Q

what testing must be done before starting any treatments in primary hyperparathyroidism?

A

24- hr urine for calcium/creatinine ratio required before starting any treatments

38
Q

what if a 24- hr urine for calcium/creatinine ratio reveals extreme elevations of serum calcium and PTH?

A

they got parathyroid cancer

39
Q

what are the 2 methods of measuring serum calcium in regards to albumin results?

A
  1. measure total serum Ca 2+ if normal albumin
  2. measure ionized Ca 2+ if low albumin
40
Q

what will an EKG show in PRIMARY HYPERPARATHYROIDISM?

A
  1. AV block, shortened QT interval
  2. Osborn J waves w/ severe hypercalcemia >14
41
Q

what imaging methods should be used in primary hyperparathyroidism?

A

ultrasound, MRI of neck, Tc99 sestamibi

42
Q

Tc99 sestamibi is performed for what?

A

to detect parathyroid adenoma

43
Q

what is the holistic tx for asymptomatic primary hyperparathyroidism?

6 things

A
  1. monitor for development of sx
  2. monitor serum calcium and albumin levels, calcium excretion, and kidney function
  3. bone density measurements (hip, spine, and forearm) every 1-2 years
  4. avoid calcium containing antacids and supplements
  5. maintain adequate vitamin D intake
  6. encourage physical activity to decrease bone resorption
44
Q

what is the pharm tx for asymptomatic primary hyperparathyroidism?

A

biphosphonate therapy
- encourage osteoclast destruction leading to decreased serum calcium levels

45
Q

what is the tx for symptomatic primary hyperparathyroidism dz or presence of parathyroid carcinoma?

A
  1. parathyroidectomy
    • will include ipsilateral thyroidectomy for those with
      parathyroid carcinoma
    • hypocalcemia and transient hyperthyroidism may
      occur postoperatively
46
Q

what is hypoparathyroidism?

A

condition that results from decreased function of parathyroid glands with underproduction of parathyroid hormone leading to hypocalcemia

47
Q

what are the causes of hypoparathyroidism?

A
  1. inadvertent damage (radiation) or removal of thyroid and/or parathyroid glands during neck surgery
  2. autoimmune disease
  3. heavy metal toxicity (iron and copper)
    • hemochromatosis and wilsons disease
  4. thyroiditis
  5. tissue resistance to PTH (pseudohypoparathyroidism)
48
Q

what is the clinical presentation of hypoparathyroidism?

A

(symptoms depend on severity, duration and rate of development)

  1. tetany:
    mild- perioral numbness, muscle cramps/spasms, paresthesias, hyperreflexia
    severe- carpopedal spasms, laryngospasm, seizures
  2. defects affecting teeth, nails and hair
49
Q

what cardiac findings are seen in hypoparathyroidism?

A

prolonged QT interval, arrhythmias, hypotension

50
Q

what is the mnemonic for hypocalcemia?

A

CATS
C- convulsions
A- arrhythmia
T- tetany
S- stridor and spasms

51
Q

what are the 2 PE findings of hypocalcemia (hypoparathyroidism)?

A
  1. chvostek
  2. trousseau
52
Q

what is chvostek sign?

A

contraction of eye, mouth, or nose muscles elicited by the tapping along the course of facial N. anterior to the ear

53
Q

what is trousseaus sign?

A

spasm in hand and wrist with compression to forearm (w/ bp cuff)

54
Q

what labs will you see in hypoparathyroidism?

A

low PTH
low serum calcium
high serum phosphorus

55
Q

what will an ekg of hypoparathyroidism show?

A
  1. prolonged QT interval
  2. arrhythmias
56
Q

what is the tx of acute severe symptomatic dz of hypoparathyroidism?

A
  1. calcium gluconate 1-2 g IV in 50 mL of 5% dextrose (or normal saline) infused over 10-20 min (1ST LINE)
  2. transition them to oral calcium supplements (patient will go home on these)
57
Q

what is the tx of mild symptomatic or chronic disease of hypoparathyroidism?

A
  1. oral calcium supplements
    • calcium carbonate (or calcium citrate) 1500-2000 mg PO daily in divided doses
  2. recombinant human PTH
58
Q

what is the tx for vitamin D deficiency

A

important to realize: vitamin D deficiency is the cause of hypocalcemia

tx:
1. cholecalciferol (vita D3)- multiple dosing regimens

ENDOCRINE (18 decks)

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