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Year 4: Endocrine > Parathyroid Disorders > Flashcards

Parathyroid Disorders Flashcards

1
Q

what do the parathyroid glands secrete?

in response to what?

A

secrete PTH from chief cells in response to low calcium

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2
Q

what does PTH do

A

Increases serum calcium

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3
Q

how does PTH increase serum calcium

A
  1. Increases osteoclast activity – reabsorption of calcium from bone
  2. increases calcium reabsorption in the kidney – decreased calcium excreted in urine
  3. stimulates kidneys to convert vit D3 to calcitriol (active form of Vit D) – increases calcium absorption form small intestine
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4
Q

causes of hypercalcaemia

A

hyperparathyroidism
bone metastasis
sarcoidosis
myeloma

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5
Q

ECG hypercalcaemia

A

short QT interval

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6
Q

symptoms of hypercalcaemia

A

“Bones stones groans + moans”

  • painful bones +/- fractures
  • renal stones
  • abdominal pain / constipation
  • depression / confusion

also:polydipsia, polyuria, dehydration

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7
Q

what is primary hyperparathyroidism

A

excess PTH production by parathyroid causing hypercalcaemia

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8
Q

most common cause of primary hyperparathyroidism

A

solitary adenoma (85%)

  • hyperplasia (15%)
  • carcinoma (<1%)
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9
Q

blood results primary hyperparathyroidism

A

increased calcium
increased/normal PTH
low phosphate
increased ALP

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10
Q

treatment of adenoma causing primary hyperparathyroidism

A

surgery

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11
Q

general management of high calcium

A

IV fluids
Loop diuretics
Treat underlying cause

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12
Q

what is secondary hyperparathyroidism

A

increased PTH in response to hypocalcaemia

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13
Q

what causes secondary hyperparathyroidism

A

Chronic renal failure
Vit D deficiency
Low calcium in diet
– low absorption of calcium from intestines bones kidneys

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14
Q

blood results secondary hyperparathyroidism

A

low calcium
high PTH
high phosphate
high ALP

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15
Q

Treatment of secondary hyperparathyroidism

A

alfacalcidiol

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16
Q

what is tertiary hyperparathyroidism

A

due to longstanding secondary hyperparathyroidism

- PTH production remains high despite increased calcium levels

17
Q

blood results tertiary hyperparathyroidism

A

high calcium
high PTH
high phosphate
high ALP

18
Q

treatment of tertiary hyperparathyroidism

A

surgical removal of hyperplasia

19
Q

what is malignant hyperparathyroidism

A

parathyroid related protein (PTHrP) is produced by malignant squamous cell carcinomas elsewhere in body and mimics PTH

20
Q

what cancers cause malignant hyperparathyroidism

A

squamous cell lung cancer
breast cancer
renal cancer

21
Q

blood results malignant hyperparathyroidism

A

decreased PTH
increased calcium
increased phosphate

22
Q

hypocalcaemia changes on ECG

A

prolonged QT interval

23
Q

what is chvostek’s sign

A

tapping over facial nerve causes twitching of facial muscles in patients with hypocalcaemia

24
Q

what is trousseau’s sign

A

inflation of BP cough above systolic BP causes hand spasm in patients with hypocalcaemia

25
Q

symptoms of hypocalcaemia

A

muscle aches
tetany - muscle spasms
pins + needles

26
Q

what is primary hypoparathyroidism

A

decreased PTH secretion

27
Q

most common cause of primary hypoparathyroidism

A

damage/accidental removal of glands secondary to thyroid surgery

28
Q

bloods in primary hypoparathyroidism

A

low PTH
low calcium
high phosphate

29
Q

treatment of primary hypoparathyroidism

A

calcium + vit D supplements

30
Q

what is pseudohypoparathyroidism

A

cells are resistant to PTH

- Abnormality in a G protein

31
Q

features of pseudohypoparathyroidism

A

low IQ
short metacarpals + short metatarsals
short stature
pixie face

32
Q

bloods in pseudohypoparathyroidism

A

high PTH
low calcium
high phosphate

33
Q

how is diagnosis of pseudohypoparathyroidism made

A

measuring urinary cAMP + phosphate levels following PTH infusion

  • both will rise in hypoparathyroid
  • neither will rise in pseudohypoparathyroid
34
Q

what is pseudopseudohypoparathyroidism

A

same feature of pseudohypoparathyroid but normal blood biochemistry

Year 4: Endocrine (15 decks)

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