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endocrine > parathyroid issues > Flashcards

parathyroid issues Flashcards

1
Q

name the parathyroid gland issues

A

hypocalcaemia
hypoparathyroidism
- primary - parathyroid gland issue
- secondary - external issue effecting parathyroid
pseudohypoparathyroidism

hypercalcaemia
hyperparathyroidism

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2
Q

Aetiology (causes) of hypocalcaemia (4)

A
  • CKD (due to decreased Vit D activation)
  • Severe Vit D deficiency
  • Primary hypoparathyroidism
  • Acute pancreatitis
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3
Q

A patient may develop hypocalcaemia after thyroid surgery, why?

A

The parathyroid glands may be (accidentally or deliberately) removed during thyroid surgery which will cause acute (sudden) hypoparathyroidism.

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4
Q

Drugs that can cause hypocalcaemia (4)

A
  • Bisphosphonates
  • Phenytoin
  • Loop diuretics
  • Cinacalcet
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5
Q

ECG in hypocalcaemia

A

Longer QTc and ST segment

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6
Q

How does hypocalcaemia affect muscle?

A

Muscle spasms: hands, feet, larynx, premature labour

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7
Q

How does hypocalcaemia affect PTH? (2)

A
  • Always increases
  • Except in hypoparathyroidism
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8
Q

response to hypocalcaemia? (6)

A

inc PTH secretion
inc bone reabsorption
dec in urinary excretion
inc calcium reabsorption
inc in 1,25 vitamin D3 production
increase in calcium and phosphate reabsorption in intestine

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9
Q

Symptoms/Signs of hypocalcaemia and hypoparathyroidism (8)

A
  • Parasthesia
  • Tetany (involuntary muscle contractions)
  • Chvostek sign - facial muscle spasm after tapping on nerve
  • Trousseau sign - inflate blood pressure cuff and observe hand muscle spasm
  • seizures
  • basal ganglia calcification
  • cataracts
  • ECG abnormalities
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10
Q

Treatment of hypocalcaemia (2)

A
  • Oral calcium replacement or IV calcium gluconate
  • Treat the cause
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11
Q

hypocalcaemia tests

A
  • ECG - long QT INTERVAL
  • chvosteks sign
  • trousseaus sign
  • serum total Ca below 8.5
  • ionized blood below 4.4
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12
Q

PTH regulation

A
  • Tightly regulated by body Ca2+ to prevent hyper/hypocalcaemia
  • Directly inhibited by calcitonin - from parafollicular C cells fo the thyroid
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13
Q

normal serum calcium levels

A

Total calcium: 8.5 to 10.2 mg/dL (milligrams per deciliter)
Ionized (free) calcium: 4.4 to 5.4 mg/dL

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14
Q

causes of hypoparathyroidism (7)

A

Syndromes - eg Di george
Genetic
Surgical
Radiation
Autoimmune - eg polyglandular type 1
Infiltration - wilsons disease
Magnesium deficiency

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15
Q

hypoparathyroidism overview

A
  • insufficient PTH release
    leads to:
  • hypocalcemia (because it usually promotes bone breakdown)
  • hyperphosphatemia (because it usually inc kidney excretion)
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16
Q

hypoparathyroidism PTH, Ca and phosphate

A

PTH - low
Ca - low
phosphate - high

17
Q

what is Pseudohypoparathyroidism

A

Resistance to parathyroid hormone
Type 1 Albright hereditary osteodystrophy
– mutation with deficient Gα subunit

18
Q

Pseudohypoparathyroidism presentation (6)

A

Short stature
Obesity
Round facies
Mild learning difficulties
Subcutaneous ossification
Short fourth metacarpals
Other hormone resistance

19
Q

Pseudohypoparathyroidism hormone levels

A

PTH - high
Ca - low
phosphate - high

19
Q

Management of mild Hypocalcaemia

A
  • Ca suppliments
  • post-thyroidectomy Ca suppliments and 1-alphacalcidol
  • vit D deficiency - cholecalciferol
  • if hypomagnesia - replace magnesium
20
Q

Management of severe Hypocalcaemia

A

10-20mls of 10% calcium gluconate over 10 mins (in 50-100mls of 5% dextrose)

Dilute 100mls of 10% calcium gluconate in 1L of Normal saline (at 50-100mls/hour)

Post-operative hypocalcaemia or hypoparathyroidism give 1-alphacalcidol 0.25mcg/day

21
Q

hypercalcaemia symptoms

A

Thirst, polyuria
Nausea
Constipation
Confusion
Coma

22
Q

hypercalcaemia consequences

A

Renal stones
ECG abnormalities
Short QT

23
Q

hypercalcaemia causes

A

Malignancy
bone mets, myeloma, PTHrP, lymphoma
Primary hyperparathyroidism
MOST COMMON 3
Thiazides
Thyrotoxicosis
Sarcoidosis
Familial hypocalciuric / benign hypercalcaemia
Immobilisation
Milk-alkali
Adrenal insufficiency
Phaeochromocytoma

24
Q

hormone levels of hypercalcaemia of malignancy

A

PTH - low
Ca - high
phosphate not stated

25
Q

Consequences of Primary Hyperparathyroidism

A

Osteitis fibrosa cystica
Osteoporosis
Kidney stones
confusion
Constipation
Acute pancreatitis

26
Q

main cause of primary hyperthyroidism

A

tumour

80% single benign adenoma

27
Q
A
28
Q

primary hyperparathyroidism hormone levels

A

PTH - high
Ca - high
phosphate - low

29
Q

Management of Hypercalcaemia

A

Intravenous fluids Normal 0.9% saline

Loop diuretic if risk of overload ONLY

Intravenous bisphosphonates e.g pamidronate,
zoledronic acid (make sure PTH sample taken)

Corticosteroids e.g Vitamin D intoxication, sarcoidosis

Denosumab – Rank ligand inhibitor

Cinacalcet – Calcium sensory receptor agonist

30
Q
A

endocrine (22 decks)

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