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Endocrine > Parathyroid Pathology > Flashcards

Parathyroid Pathology Flashcards

1
Q

Describe the pathophysiology of hypocalcaemia?

A

Neurons are more excitable

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2
Q

What are the causes of hypocalcaemia?

A

Primary hypoparathyroidism

  • Total thyroidectomy
  • Selective parathyroidectomy
  • Post-radiation

Severe vitamin D deficiency

Hypomagnesaemia Mg2+ deficiency

Cytotoxic drug-induced hypocalcaemia

Hypoalbuminaemia

Acute pancreatitis

Pseudohypoparathyroidism

Pseudopseudohypoparathyroidism

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3
Q

What is Pseudohypoparathyroidism?

A

Cells resistant to PTH

Pixie face, short metacarpals and metatarsals

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4
Q

What is Pseudopseudohypoparathyroidism?

A

Same morphological features as pseudohypoparathyroidism, but normal biochemical profile

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5
Q

How does hypocalcaemia present?

A

SPASMODIC

Parathesia

Seizures/tetany

Disorientation/dementia

Dry skin/Impetigo

Muscle twitching/spasms

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6
Q

What is Trousseau’s sign?

A

Wrist spasm

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7
Q

What is Chovstek’s sign?

A

Facial twitching

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8
Q

What is Carpopedal Spasm?

A

Feet or hand spasm

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9
Q

What investigations are used in hypocalcaemia diagnosis?

A

<ca2>

<p>Vitamin D</p>

<p><pth>

<p>Albumin</p>

<p>Magnesium</p>

<p>Phosphorus</p>

<p>ECG: Prolonged QT</p></pth></p></ca2>

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10
Q

How is hypocalcaemia managed?

A

Calcium and Vitamin D supplements

Recombinant human Parathyroid hormone

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11
Q

Give complications of hypocalcaemia

A

Hypotension

HF

Arrythmia

Laryngospasm/Bronchospasm

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12
Q

Describe the pathophysiology of hypercalcaemia

A

Neurons are less excitable

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13
Q

What causes hypercalcaemia?

A

Hyperparathyroidism

  • Adenoma
  • Carcinoma
  • Hyperplasia

Bone Metastasis

  • Lung
  • Breast

Renal disease

Sarcoidosis

Endocrine

  • Acromegaly
  • Addisons
  • Thyrotoxicosis

Drugs

Dehydration

Familial Hypocalciuric Hypercalcaemia

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14
Q

What is the most common cause of hypercalcaemia?

A

Malignancy is most common in hospital, whereas hyperparathyroidism is most common in the community

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15
Q

How does hypercalcaemia present?

A

Stones, groans, bones and moans

Dehydration: Loss of calcium in urine

Bone pain: De-mineralisation to release Ca2+

Muscle weakness

Polydipsia/polyuria: Diabetes Insipidus

Confusion: Especially in the elderly

Depression

Constipation

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16
Q

What investigations are used in hypercalcaemia diagnosis?

A

>Ca2+

>PTH (can also be normal in primary hyperparathyroidism)

PTH-related peptide

Vitamin D

TFTs

Tumour markers

ECG, shortened QT interval

Imaging

  • Bone scan
  • CXR
  • Mammogram
17
Q

How is hypercalcaemia managed?

A

IV fluids, first line

Loop diuretics

Parathyroidectomy

Bisphosphonates

Calcimimetics, drugs that imitate calcium

18
Q

When is a parathyroidectomy carried out?

A

If Ca2+>3mmol/l + symptomatic/renal stones

19
Q

Give an example of a bisphosphonate?

A

Alendronate

20
Q

What is a complication of hypercalcaemia?

A

Kidney/gallbladder stones

21
Q

What is secondary hyperparathyroidism?

A

Raised PTH in response to low calcium

22
Q

What is tertiary hyperparathyroidism?

A

Prolonged/untreated secondary hyperparathyroidism occuring almost exclusively in patients with kidney disease causing ongoing hyperplasia the gland

23
Q

What causes hyperparathyroidism?

A

Solitary parathyroid adenoma

Hyperplasia of parathyroid gland

Autoimmune

HIV

DiGeorge

Multiple Endocrine Neoplasia (MEN) Syndromes 1 and 2

Secondary: Renal failure, Vitamin D deficiency

24
Q

What is the most common cause of hyperparathyroidism?

A

Solitary parathyroid adenoma, 85% of causes

25
Q

How is hyperparathyroidism managed?

A

High fluid intake

  • To prevent stone formation

Surgical resection of parathyroid gland

26
Q

What is a complication of hyperparathyroidism?

A

Risk of transient hypocalcaemia post-operatively

27
Q

What conditions are associated with Multiple Endocrine Neoplasia (MEN) 1?

A

Hyperparathyroidism/parathyroid adenoma

Pancreatic

  • Insulinoma

Pituitary

28
Q

What conditions are associated with Multiple Endocrine Neoplasia (MEN) 2?

A

Hyperparathyroidism

Phaechromocytoma

Medullary thyroid cancer

29
Q

What electrolyte abnormality is associated with hypercalcaemia?

A

Hypernatraemia

30
Q

What is important to note about PTH levels in primary hyperparathyroidism?

A

PTH may be normal

31
Q

What drugs can cause hypercalcaemia?

A

Thiazide diuretics

32
Q

When is an IV biphosphonate indicated?

A

Ca over 3 mmoles/l

33
Q

Describe the hormone profile of primary hyperparathyroidism

A

increased or inappropriately normal PTH

increased Ca

decreased phosphate

increased ALKP

34
Q

Describe the hormone profile of secondary hyperparathyroidism

A

increased PTH

normal or decreased Ca

increased phosphate

decreased vit D

35
Q

Describe the hormone profile of tertiary hyperparathyroidism

A

significantly increased PTH

normal or increased Ca

normal or decreased phosphate

normal or decreased vitamind D

increased ALKP

36
Q

What x-ray sign can be seen in hyperparathyroidism?

A

Pepper pot skull

37
Q

How is hypomagnesaemia managed?

A

<0.4 mmol/L or tetany, arrhythmias, or seizures

  • IV magnesium replacement

>0.4 mmol/l

  • Oral magnesium salts, although diarrhoea can occur

Endocrine (7 decks)

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