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RRCCPA Clinical Medicine I > Parathyroid Disorders (Exam 3) > Flashcards

Parathyroid Disorders (Exam 3) Flashcards

1
Q

How many parathyroid glands are there typically? Where are they located?

A

There are usually 4 parathyroid glands they are located posterior to each pole of the thyroid

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2
Q

What hormone do the parathyroid glands release? What is the function of the hormone?

A

The parathyroid glands release parathyroid hormone (PTH) which regulates serum calcium levels.

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3
Q

What are the functions of serum Ca 2+?

A
  • Muscle contraction
    • Terminal neurons release Ca 2+ ions that bind to activator proteins which signal muscles to contract and relax
  • Ca 2+ stabalizes cardiac cell membranes against depolarization in severe hyperkalemia (too much potassium)
  • Essentail element of bone mineralization
  • Important in blood clotting
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4
Q

Bone has many uses when it comes to Ca 2+ what can is serve as?

A

A reservoir for Ca 2+

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5
Q

Hypercalcemia and hypocalcemia can lead to issues with which vital organ?

A

The heart, can cause arrhythmias

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6
Q

To maintain homeostatic levels of Ca 2+ the body needs how many functioning parathyroid glands?

A

1

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7
Q

In the event of low Ca 2+ serum levels PTH stimulates which cells within bone to break down the bone matrix and release Ca 2+ into the blood stream?

A

Osteoclasts

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8
Q

Oh snap! Blood serum levels of Ca 2+ are low, the body senses this and the parathyroid releases PTH. PTH reaches the kidneys, they respond by doing two things, what are they?

A

Reducing Ca 2+ clearance in the urine and stimulating production of 1.25dihydroxyvitaminD (Calcitriol) which stimulates the absorption of Ca 2+ in the GI tract.

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9
Q

DDX for elevated calcium (Hypercalcemia)

A
  • Primary hyperparathyroidism
  • Familial hypocalciuric hypercalcemia
  • Lithium
  • Sarcoidosis
  • Genetic disorders: multiple endocrine neoplasia, familial hyperparathyroidism
  • Renal failure acute or chronic
  • Vitamin D excess
  • Granulomatous disease
  • Williams syndrome
  • Endrocrine disease: thyrotoxicosis, adrenal insufficiency
  • Milk-Alkali syndrome
  • Thiazide diuretics (She mentioned these a lot!)
  • Cancers: Multiple myeloma, head, neck, lung, lymphoma
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10
Q

When serum Ca 2+ levels are high osteo____ activity increases

When serum Ca 2+ levels are low osteo____ activity increases

A
  1. Osteoblast activity increases in response to high levels of serum Ca 2+
  2. Osteoclast activity increases in response to low levels of serum Ca 2+ (Osteoclasts break down bone and release Ca 2+ into the blood)
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11
Q

Cause of 80% of hyperparathyroidism, leading to hypercalcemia

A

Benign parathyroid adenomas

Most common in women 3:1

Increased incidence after age 50

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12
Q

Besides benign parathyroid adenomas what are otther causes of hypercalcemia?

A
  • Renal failure
  • multiple myeloma
  • Head, neck, and lung cancers
  • TB
  • Medications
  • lymphoma
  • Adrenal insufficiency
  • Hyperthyroidism
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13
Q

The sign and symptoms of Hypercalcemia as a result of hyperparathyroidism are best summerized by the mnemonic “Stones, bones, abdominal groans, throans, and psychiatric overtones” What the hell does that mean?

A
  • Stones
    • Kidney stones (Calcium Oxalate)
  • Bones
    • Bone diseases of hyperparathyroidism
      • Osteitis fibrosa cystica (some bones become abnormally weak and deformed)
      • Osteoporosis
      • Osteomalacia (softening of bones)
      • Arthritis
  • Abdominal groans
    • N/V/D
    • Constipation (Most common)
    • PUD (Peptic ulcer disease)
    • Pancreatitis
  • Thrones
    • Polyuria
    • Constipation
  • Psychiatric overtones (from effects on the CNS)
    • Depresson
    • Memory loss
    • Psychosis
    • Delerium
    • Fatigue
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14
Q

Clinical features of hyperparathyroidism

A
  • Thirst
  • Anorexia
  • Nausea
  • Vomiting
  • Abdominal pain
  • Constipation (A big sign)
  • Fatigue
  • Anemia
  • Wight loss
  • PUD (Peptic ulcer disease)
  • Pancreatitis
  • HTN
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15
Q

Halmark lab finding for a Dx of Hyperparathyroidism

A

Adjusted total calcium greater than 10.5 mg/dl

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16
Q

Which lab test is needed to see calcium levels

A

Comprehensive metabolic panel

17
Q

Findings that can lead you to a Dx of Hyperparathyroidism

A
  • Adjusted total calcium greater than 10.5 mg/dl (Hallmark finding)
  • Elevated PTH
  • Low phosphate level
  • Imaging studies–ultrasound, CT, MRI, sestamibi scan
  • EKG may show prolonged PR, shortened QT, bradycardia, heart block, and eventually asystole
18
Q

Patients who have elevated calcium levels should be screened for what?

A

Familial hypocalciuric hypercalcemia (Gene mutation that leads to elevated calcium levels)

19
Q

Treatment for hyperparathyroidism

A
  • Avoid foods and medications that increase calcium levels (thiazide, diuretics, antacids, large doses of vit. A and D)
  • Furosemide is a diuretic that may be used as it increases the amount of calcium lost in urine
  • Increase fluids
  • Exercise
  • Monitor with scheduled serum calcium and albumin levels, kidney fxn test, urinary calcium excretion, and bone density
  • If hypercalcemic crisis occurs treat with IV fluids and bisphosphonates
  • A parathyroidectomy is indicated when symptomatic primary disorder
20
Q

How would you treat a patient in hypercalcemic crisis

A

IV fluids and bisphosphonates

21
Q

When would a parathyroidectomy be indicated

A
  • In symptomatic primary hyperparathyroidism
  • If serum Ca2+ is 11.5 mg/dl or greater
  • Creatinine clearance less than 60 ml/minute
  • Bone mineral density T score less than 2.5 at the hip, spine or wrist and/or history of previous fragility fracture
  • Age less than 50
22
Q

If a parathyroidectomy is not done in a patient for whom it is indicated what needs to be done?

A
  • Closely monitor serum Ca2+ and creatinine levels annually
  • Bone density checks every 1-2 years
23
Q

Which is more common hyperparathyroidism or hypoparathyroidism

A

Hyperparathyroidism is more common

24
Q

Findings that indicate hypoparathyroidism

A
  • Decreased PTH
  • Low calcium
  • Increased phosphate levels
25
Q

Common causes of hypoparathyroidism

A
  • Aquired most commonly after surgical removal of thyroid or parathyroid glands
  • Autoimmunity
  • Heavy metal toxicity
    • Wilson’s disease
      • Genetic disorder that causes the accumulation of copper in the body
    • Hemochromatosis
      • Accumulation of Iron
  • Thyroiditis
  • Hypomagnesemia (caused by alcoholism)
  • DiGeorge syndrome
    • congenital cause of low Ca 2+ arising from parathyroid hypoplasia
  • Congenital pseudohypoparathyroidism
26
Q

Clinical features of hypoparathyroidism (theres a lot of them)

A
  • Abdominal cramps
  • Muscle cramps
  • Tetany
  • Carpopedal spasm
  • Paresthesias
  • Numbness/tingling especially around mouth or fingers
  • Hyperreflexia
  • Teeth, hair, and nail defects
  • Lethargy
  • Anxiety
  • Parkonsonism
  • Mental retardation
  • Blurred vision from cataracts
  • Personality changes
  • Bronchospasm
  • Seizures
27
Q

Contraction of eye, nose, or mouth by tapping facial never anterior to ear is what sign?

A

Chvostek sign (indicates hypocalcemia)

28
Q

A spasm produced in the hand and wrist with compression to forearm (such as applying a BP cuff).

A

Trousseau sign (indicates hypocalcemia)

29
Q

Hallmark signs to make diagnosis of hypoparathyroidism

A
  • Low PTH
  • Low adjusted calcium
  • Increased phosphate
  • EKG may show prolonged QT, T-wave abnormalities
30
Q

As Ca2+ increases, Phosphate ____

A

Decreases (vice versa is true too as Ca2+ decreases phosphate increases)

31
Q

Treatments for hypoparathyroidism

A
  • Directed at increasing Calcium levels (goal calcium level is 8.0-8.6 mg/dl)
  • Calcium and vit D supplements
  • Monitor adjusted serum calcium levels and urine calcium levels
  • Avoid furosemide and other meds that increase calcium loss
  • Thiazide diuretics increase calcium levels so they are safe to use
  • Emergency treatment with IV calcium gluconate
  • May use Teriparatide (recombinant PTH) off label in extreme cases to increase PTH levels.

RRCCPA Clinical Medicine I (49 decks)

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