Parathyroid Hormone Flashcards
Signs of hyper PTH
Hypercalcaemia signs - weak, tired, depressed, thirsty, dehydrated but polyuric
Painful bones, renal stones, abdominal groans and psychic moans
Systemic Complications of hyperPTH
Renal stones, abdominal pain, pancreatitis and ulcers
What is high in hyperPTH
Calcium
PTH
ALP
Imaging in hyperPTH
Osteitis fibrosa cystica
- subperiosteal erosions of phalanges
- cysts
- pepper pot skull
- sclerosis of superior and inferior vertebral margins (of vertebral disc) with central demineralisation ‘rugger jersey’ spine - white at top and bottom of vertebra and dark in middle
Renal calculi/nephrocalcinosis
Treatment of mild hyperPTH
Increase fluid intake - prevent stones
Avoid thiazides
Avoid high calcium and vitamin d intake
Drug treatment of hyperPTH
Cinacalcet - increases pt sensitivity to calcium
Surgical - subtotal parathyroidectomy
What is secondary hyperPTH
Due to low calcium causing increased secretion of PTH
Eg. chronic renal failure or vitamin D deficiency
Tertiary hyperPTH
From prolonged low calcium and therefore chronic secondary hyper PTH - glands autonomously produce PTH in excess
Malignant hyperPTH
PTH produced by some SCC - lung, breast, and renal
Pseudohypoparathyroidism signs
Resistance of target cells to parathyroid hormone
Short metacarpals
Round face
Short stature
Calcified basal ganglia
PTH is suitably high. Phosphate is high. Calcium is low.
Overall effect of PTH
High calcium and low phosphate
Treatment of secondary hyperPTH
Treat underlying renal failure - calcium and vitamin D supplements
What is primary hyperPTH
Increased secretion of PTH unrelated to plasma calcium concentration
eg. parathyroid gland adenoma or hyperplasia
Serum calcium in hyperPTH
High in primary and tertiary
Low or normal in secondary
Phosphate in hyperPTH
Low in primary and tertiary
High in secondary
