Parathyroid Gland ☺️

Question 1

Location of parathyroid
Function
Control

Answer 1

4 glands behind thyroid => increases Ca

Bone - Ca release
Kidney - Ca, Mg uptake, decreased PO4 uptake
Intestine via kidney - increased activated VitD => increased gut Ca uptake

-ve feedback of Ca in blood via calcitonin

Question 2

Primary hyper PTH

• hormone profile
• presentation
• causes
• management

Answer 2

High PTH, Ca
Low PO4

Asymptomatic
Recurrent abdo pain (pancreatitis, renal colic)

Most common - adenoma

Surgery if

• Ca 1mg+ greater than normal/lifethreatening
• Hypercalciuria
• Decreased creatinine clearance
• Renal stones
• Osteoporotic
• NM symptoms
• 50+

Question 3

Secondary hyperPTH

• hormone profile
• presentation
• causes
• management

Answer 3

High PO4
Low/normal Ca
Low VitD

Most often => CKD PT hyperplasia
-bone disease, soft tissue calcification

Medical and lifestyle - USUALLY ENOUGH

• PO4 binders/low diet
• calcimimetics/Ca supplements/high diet
• VitD supplements/high diet

Surgery

• bone pain
• persistent itch
• calciphylaxis

Question 4

Tertiary hyperPTH

• hormone profile
• presentation
• causes
• management

Answer 4

High PTH
Normal/high Ca
Normal/low PO4, VitD
High ALP

Metastatic calcification
-bone pain/fracture
Kidney stones
Pancreatitis

Most often => ongoing renal related hyperplasia (autonomously functioning gland

Surgery - total parathyroidectomy

Question 5

Hypocalcemia

• causes
• management

Answer 5

VitD deficiency => osteomalacia
Mg deficiency (due to end organ PTH resistance)
CKD
HypoPTH (after thyroid/parathyroid surgery)
PseudohypoPTH (target resistance)
Acute pancreatitis
Transfusion
EDTA contamination of blood samples

IV Ca gluconate (10ml 10% solution in 10mins
ECG monitoring
Underlying cause