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Mariam Endocrine > Parathyroid Pathology > Flashcards

Parathyroid Pathology Flashcards

1
Q

Aetiology of hypoparathyroidism

A

Parathyroidectomy
Thyroidectomy
AutoimmuneGenetic- DiGeorge Syndrome- undevelopment pharygneal pouches

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2
Q

Aetiology of hyperparathyroidism

A

85% due to parathyroid adenoma
15% Four gland hyperplasia
MEN
Parathyroid Carcinoma

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3
Q

Aetiology of Hypocalceima

A 
PTH Defiency - parathyroid gland damaged
Vit D defiency
Renal failure
Mg 2+ defiency
Infection - HIV
Tumours
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4
Q

Aetiology of Hypercalcaemia

A

90% are either:

  • Primary Hyperparathyroidism
  • Malignant Hypercalcaemia
Other:
MEN
Familial Hypocalciuric Hypercalcaemia (FHH) 
-Drugs e.g. Thiazide diuretic or Lithium
Vit D Vit A
Sarcoid
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5
Q

How does Hypercalcaemia present?

A

GI:

  • Anorexia
  • Constipation
  • N&V

CV:
Short QT,
Hypertension
Bradycardia

Neuro
Loss of Conc. & confusion

Renal
Polyuria & Polydipsia +
Nephrolithiasis

MSK - Muscle Weakness & bone pain

BONES STONES GROANS & PSYCHIATRIC MOANS

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6
Q

How does Primary Hyperparathyroidism present?

A

Its generally asymptomatic but can cause symptoms of hypercalcaemia

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7
Q

What is Familial Hypocalciuric Hypercalcaemia?

A

An autosomal dominant disorder causing

Calcium-Sensing Receptor (CaSR) defects

Pathophysiology:

Increased Ca2+ reabsorption - therefore lowcalcium in uria

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8
Q

What tests are appropriate for Hypercalcaemia? (hint there’s loads)

A
  • Serum Ca, PO4, PTH & Albumin
  • Serum ACE (Sarcoid)
  • 24 hour urine collection for calcium (low = FHH)
  • U&Es
  • ALKP
  • Lymph node exam (malignancy)
  • Myeloma screen (osteolytic metastases)
  • ECG (short QT)
  • FH
  • Med History
  • Abdo US for kidney stones
  • Parathyroid US for adedomas etc.
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9
Q

What are the initial tests for hypercalcaemia?

A

Serum Ca / PO4 / PTH / AlbuminFH & Med history

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10
Q

What are the “levels” of hypercalcaemia?

A

<3mmol/l - Generally aymptomatic

3-3.5mmol/l -~symptomatic & prompt treatment needed

> 3.5mmol/l - Emergency. Risks Dysrhythmia & coma”

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11
Q

How do you treat hypercalcaemia first?

A

Rehydration & IV bisphosphonates (inhibit osteoclasts)

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12
Q

What can you give hypercalcaemics when bisphosphonates fail/arn’t tolerated?

A

Calcitonin- opposes effect of PTH and reduces serum Ca 2+ levels

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13
Q

What treatments are there for lymphoma or granulomatous disease causing hypercalcaemia?

A

Glucocorticoids e.g. Hydrocortisone

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14
Q

How would we treat Primary Hyperparathyroidism Hypercalcaemia?

A

Parathyroidectomy OR Calcimetics e.g. Cinacalcet

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15
Q

What is Pseudohypoparathyroidism?AKAalbright hereditary osteodystrophy

A

A set of disorders in which target organs like kidneys & bone become unresponsive to PTHFeatures:

Shortened 4th and 5th digits

Short

Obese

Developmental delays

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16
Q

At what Serum Ca2+ level do symptoms of hypocalcaemia appear?

A

Around 1.9mmol/l

17
Q

How does chronichypocalcaemia present?

A

Parkinsonism

Dementia

Subcapsular Cataracts

Abnormal Dentition

Dry Skin

Ectopic calcification

18
Q

How does acute hypocalcaemia present?

A

Lots of symptoms, main ones are:

  • Paraesthesia
  • Muscle twitching
  • Trosseaus sign (bp cuff)
  • Chovstek’s Sign (face)

Prolonged QT

Hypotension

Papilloedema

19
Q

What tests are appropriate for Hypocalcaemia?

A

Adjusted Ca,

albumin,

PO4

PTH (High Pseudoparathyroidism vs low Hypoparathyroidism)

Mg (Mg deficiency)

U&Es (renal failure)

Vit D (Vit D deficiency)ECG

20
Q

Explain how blood tests will appear for the 3biggest causes of hypocalcaemia?

A

Vit D deficiency - Low Ca, low PO4 & high PTH

Hypoparathyroidism - Low Ca, High PO4 & low PTH

Pseudoparathyroidism - Low Ca, High PO4 and high PTH

21
Q

How do you treat mild Hypocalcaemia?

A

Mild meaning >1.9mmol/l and asymptomatic.

Oral Ca2+

Supplements Vitamin D & Magnesium

22
Q

How do you treat severe hypocalcaemia?

A

Severe meaning symptoms or <1.9mmol/l

Considered a medical emergency

IV Calcium Gluconate

Then treat cause e.g. 2g IV Magneiusm Sulfate

23
Q

How to work out adjusted calcium

A

Some calcium is albumin bound, to find a true serum calcium do serum calcium and serum albumin.

Then add 0.1mmol/l for every 5g/l reduction in Albumin from 40g/l

24
Q

Management of hyperparathyroidism

A

Primary hyperparathyroidism:
Parathyroidectomy

Secondary Hyperparathyroidism:

Vitman D
Renal therapy

Mariam Endocrine (24 decks)

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