Parathyroid Pathology Dr. Singh

Question 1

3 types of cells in parathyroid

Answer 1

1. Chief cell ( secreting PTH)
2. Oxyphil cell
3. Adipocytes

Question 2

PTH causes

Answer 2

Release CA+ to be released from bone
Kidney (STOP excrete CA, maintain P)
Covert Vit D to make for CA

Question 3

Hyperparathyroidism primary vs secondary

Answer 3

1. Primary : high PTH + high Ca

2. Secondary : low PTH + high Ca

Question 4

3 causes of Primary Hyperparathyroidism

Answer 4

1. Adenoma
2. Primary hyperplasia
3. Parathyroid Carcinoma

Question 5

Primary Hyperparathyroidism SX

Answer 5

1. Bone pain (osteoporosis)
2. Renal stones (Nephrolithiasis) , heart valve calcification
3. ABD groans (C, gallstones)
4. Psych moans (Depression…)
   Bones, stones, groans, moans

Question 6

Osteitis Fibrosis Cystica

1. Looks like what
2. Cause
3. Can be mistake or look like

Answer 6

Brown tumors*, bone destruction that makes a hemorrhagic lesion , not neoplastic (from osteoclasts)
= can look like Metastatic disease

Question 7

Primary Hyperparathyroidism in real world sx

Answer 7

None, just see high CA

Question 8

Parathyroid adenoma

1. How to know where it is
2. H. Levels
3. Which cells are involved
4. What ends up happening as a result

Answer 8

1. Technetium Scan : radioactive gland lights up at adenoma
2. High PTH , high CA
3. Chief cells, or oxyphil cells (large CA in blood)
4. Large CA in blood causes normal parathyroid to involute/shrink

Question 9

MEN 1 and parathyroid adenoma

1. Germline vs sporadic more common

Answer 9

1. Somatic mutation (sporadic) = more common , germline (familial)
2. Have to remove thyroid completely and parathyroid

Question 10

Primary hyperplasia Parathyroid

1. Can happen how
2. Primary vs Secondary
3. Histo
4. TX

Answer 10

1. Usually all 4 hyperproliferate
2. Primary (all 4 just decide to proliferate), Secondary (low CA in body causes proliferation)
3. No fat cells seen, entire gland if full of endocrine cells
4. Parathryoidectomy (PTH lowers within minutes)

Question 11

Parathyroid Carcioma parathyroid

1. M/B
2. Histo
3. Another DX way to see this it happening

Answer 11

1. Metastatic when dx
2. Invasion of adjacent tissue + vascular invasion
3. Adenoma was removed or parathyroids removed and PTH does not go down

Question 12

Most common cause of hypercalcemia** (when PTH is low)**

Answer 12

Malignancy causing high CA

Other causes, high VITD, excess CA injection, Thiazides diuretics

Question 13

hypercalcemia with PTH low

1. Hormone levels
2. SX

Answer 13

1. High CA, low PTH

2. More symptoms then high CA from hyperparathyroidism (Mental status changes, N/V, Short QT)

Question 14

1. Asymptomatic hypercalcemia
2. Symptomatic hypercalcemia
   What do you think

Answer 14

1. Primary Hyperparathyroidism

2. Malignant Hypercalcemia

Question 15

Malignant Hypercalcemia

3 MOA If happens and what types of cancer it involves

Answer 15

1. PTHrP secretary (PTH like protein) = usually SCC lung, breast, other, = biphosphatase treated
2. Vit D excess (sarcoidosis, lymphomas) = steroid treated
3. Local Osteolytic Hypercalcemia = malignancy in bone (breast cancer and myeloma) = increases osteoclasts

Question 16

Hypocalcemia SX

Answer 16

1. Tetany (Chvosteks sign + Trousseau sign)
2. Prolonged QT
3. Muscle cramps
4. Numbness paresthesia

Question 17

High PTH and low CA

Is called what and cause

Answer 17

1. Secondary Hyperparathyroidism (reactive hyperplasia)

2. Renal disease causing dumping of CA + P resorption

Question 18

Renal Osteodystrophy
1 .can happen from
2. Can lead to

Answer 18

1. Secondary Hyperparathyroidism** (usually) , can in primary Hyperparathyroidism
2. Rugger jersey sign (bone eroding) vertebral bodies in middle hollowing out

Question 19

Calciphylaxis

1. Consequence of what
2. What happens

Answer 19

1. Secondary hyperparathyroidism (usually due to renal disease)
2. Extensive calcification and occlusion of BVs = ischemia, gangrene = die from infection/sepsis

Question 20

2 highs that happen in secondary hyperparathyroidism

Answer 20

1. Calciphylaxis

2. Renal Osteodystrophy

Question 21

Tertiary hyperparathyroidism

Answer 21

After prolonged hypoglycemia = the parathyroids hyperplasia cant shut down, even when CA is back to normal PTH is still screamed a lot like before
= same lab values as in primary hyperparathyroidism (only has secondary hyperparathyroidism first)

Question 22

Primary Hypoparathyroidism :

1. Labs
2. 5 causes

Answer 22

LOW CA, LOW PTH

1. Surgery ** MOST COMMON**
2. Autoimmune
3. DiGeorges syndrome ( absent or not developed parathyroids, 3rd + 4th pharyngeal punch prob)
4. CASR Germline mutation (AD, hypersensitive CA receptors)
5. Familial Isolated Hypoparathyroidism : PTH can be made to functional state

Question 23

DiGeorges syndrome

1. Chr problem
2. What happens in this

Answer 23

1. Chr 22q11.2
2. Immune deficiency (thymic hypoplasia) (Parathyroid hypoplasia/ aplasia = HYPOCALCEMIA) = arched back in child from tetany
3. Heart outflow defects (Tetrology of fallot, Truncus arteriosus) = blue fingers and toes and lips
4. Face : wide face, broad nose, low set ears, long upper lip, heavy eyelid)

Question 24

Inactivated CASR (loss of function mutation)

1. What happens
2. Casing
3. Contain it is called

Answer 24

1. CA receptors in parathyroid think there is never enough CA
2. Hypercalcemia from excess PTH secretary and low renal excretion
3. Familial hypocaciuric hypercalcemia

Question 25

Activated CASR (gain of function mutation) 1. What happens 2. Casing 3. Contain it is called

Answer 25

1. CA receptors in parathyroid think there is ALWAYS enough CA 2. Hypocalcemia from low PTH secretion and high renal excretion 3. AD hypoPTH

Question 26

Pseudohypoparathyriodism 1. Hormone levels 2. What happens 3. You seen this in association with what usually

Answer 26

1. HIGH PTH, low CA (only no renal dysfunction or gastric bypass surgery or low VitD = causes of secondary hyperparathyroidism) 2. PTH resistance at kidneys and bones 3. Associated with Albrights Hereditary Osteodystrophy

Question 27

Albrights Hereditary Osteodystrophy SX

Answer 27

1. Short stature + obese 2. Short phalanges, of upper extremities 3. Short phalanges of lower extremities + dental probs, subQ ossification, cataracts + seizures + tetany

Question 28

45 yo male fracture from gripping rail CA = 13 (8.5-10.2) PTH = 3,590 (10-65)

Answer 28

HIGH PTH, high CA | = probable parathyroid mass