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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
what is going on with PTH and calcium in secondary hyperparathyroidism?
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
what is the most likely cause of secondary hyperparathyroidism?
chronic renal failure (CRF)
27
what are some big underlying conditions causing secondary hyperparathyroidism other than CRF? | three
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
what is the clinical presentation of hyperparathyroidism?
1. bone pain 2. nephrolithiasis 3. abdominal cramps and constipation 4. irritability, confusion, delirium and depression 5. muscle weakness and rapid muscle fatigue
29
what will you see on an EKG in someone with hyperparathyroidism?
short QT interval
30
what is they hyperparathyroidism clinical presentation mnemonic?
"stones, bones, abdominal groans, thrones, and psychiatric overtones."
31
what bone pains will patients with hyperparathyroidism have?
there will be bone demineralization (osteoporosis) leading to pathological fractures and cystic bone lesions
32
why will nephrolithiasis occur in hyperparathyroidism?
d/t renal loss of calcium (calcium phosphate or calcium oxalate stones)
33
what kind of abdominal pain will occur in patients with hyperparathyroidism?
peptic ulcers and pancreatitis
34
what is polyuria and polydipsia related to?
hypercalcemia-induced nephrogenic diabetes insipidus
35
what is calciphylaxis?
a clinical presentation that a patient with hyperparathyroidism may present with that is deposits of calcium in the skin and muscles
36
what will the labs of a primary hyperparathyroidism patient look like?
high serum calcium low or normal serum phosphorus high PTH low urine calcium
37
what testing must be done before starting any treatments in primary hyperparathyroidism?
24- hr urine for calcium/creatinine ratio required before starting any treatments
38
what if a 24- hr urine for calcium/creatinine ratio reveals extreme elevations of serum calcium and PTH?
they got parathyroid cancer
39
what are the 2 methods of measuring serum calcium in regards to albumin results?
1. measure total serum Ca 2+ if normal albumin 2. measure ionized Ca 2+ if low albumin
40
what will an EKG show in PRIMARY HYPERPARATHYROIDISM?
1. AV block, shortened QT interval 2. Osborn J waves w/ severe hypercalcemia >14
41
what imaging methods should be used in primary hyperparathyroidism?
ultrasound, MRI of neck, Tc99 sestamibi
42
Tc99 sestamibi is performed for what?
to detect parathyroid adenoma
43
what is the holistic tx for asymptomatic primary hyperparathyroidism? | 6 things
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
what is the pharm tx for asymptomatic primary hyperparathyroidism?
biphosphonate therapy - encourage osteoclast destruction leading to decreased serum calcium levels
45
what is the tx for symptomatic primary hyperparathyroidism dz or presence of parathyroid carcinoma?
1. parathyroidectomy - will include ipsilateral thyroidectomy for those with parathyroid carcinoma - hypocalcemia and transient hyperthyroidism may occur postoperatively
46
what is hypoparathyroidism?
condition that results from decreased function of parathyroid glands with underproduction of parathyroid hormone leading to hypocalcemia
47
what are the causes of hypoparathyroidism?
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
what is the clinical presentation of hypoparathyroidism?
(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
what cardiac findings are seen in hypoparathyroidism?
prolonged QT interval, arrhythmias, hypotension
50
what is the mnemonic for hypocalcemia?
CATS C- convulsions A- arrhythmia T- tetany S- stridor and spasms
51
what are the 2 PE findings of hypocalcemia (hypoparathyroidism)?
1. chvostek 2. trousseau
52
what is chvostek sign?
contraction of eye, mouth, or nose muscles elicited by the tapping along the course of facial N. anterior to the ear
53
what is trousseaus sign?
spasm in hand and wrist with compression to forearm (w/ bp cuff)
54
what labs will you see in hypoparathyroidism?
low PTH low serum calcium high serum phosphorus
55
what will an ekg of hypoparathyroidism show?
1. prolonged QT interval 2. arrhythmias
56
what is the tx of acute severe symptomatic dz of hypoparathyroidism?
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
what is the tx of mild symptomatic or chronic disease of hypoparathyroidism?
1. oral calcium supplements - calcium carbonate (or calcium citrate) 1500-2000 mg PO daily in divided doses 2. recombinant human PTH
58
what is the tx for vitamin D deficiency
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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