Parathyroid glands and disorders of calcium metabolism Flashcards

1
Q

PTH (Elevated)
Ca2+ (Elevated)
Phosphate (Low)
Urine calcium : creatinine clearance ratio > 0.01

A

Primary Hyperparathyroidism

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2
Q

Symptoms of Primary Hyperparathyroidism

A

May be asymptomatic if mild
Recurrent abdominal pain (pancreatitis, renal colic)
Changes to emotional or cognitive state

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3
Q

Cause of Primary Hyperparathyroidism

A

solitary adenoma (80%)
multifocal disease in 10-15%
parathyroid carcinoma in ~1%

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4
Q

PTH (Elevated)
Ca2+ (Low or normal)
Phosphate (Elevated)
Vitamin D levels (Low)

A

Secondary Hyperparathyroidism

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5
Q

Symptoms of Secondary Hyperparathyroidism

A

May have few symptoms
Eventually may develop:
- bone disease
- osteitis fibrosa cystica
- soft tissue calcifications

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6
Q

Cause of Secondary Hyperparathyroidism

A

Parathyroid gland hyperplasia due to low calcium
(almost always in a setting of chronic renal failure)

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7
Q

Ca2+ (Normal or high)
PTH (Elevated)
Phosphate levels (Decreased or Normal)
Vitamin D (Normal or decreased)
Alkaline phosphatase (Elevated)

A

Tertiary hyperparathyroidism

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8
Q

Symptoms of Tertiary Hyperparathyroidism

A

Metastatic calcification
Bone pain and / or fracture
Nephrolithiasis
Pancreatitis

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9
Q

Cause of Tertiary Hyperparathyroidism

A

ongoing hyperplasia of the parathyroid glands
after correction of underlying renal disorder
=> hyperplasia of all 4 glands is usually the cause

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10
Q

Indications for surgery in Primary Hyperparathyroidism

A

Elevated serum Calcium > 1mg/dL above normal
Hypercalciuria > 400mg/day
Creatinine clearance < 30% compared with normal
Episode of life threatening hypercalcaemia
Nephrolithiasis
Age < 50 years
Neuromuscular symptoms
Reduction in bone mineral density of the femoral neck, lumbar spine, or distal radius

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11
Q

indications for surgery in Secondary (Renal) Hyperparathyroidism

A

**NOTE usually medically managed

Bone pain
Persistent pruritus
Soft tissue calcifications

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12
Q
A
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