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ENRP Exam 2 > Parathyroid Pathology Dr. Singh > Flashcards

Parathyroid Pathology Dr. Singh Flashcards

1
Q

3 types of cells in parathyroid

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

PTH causes

A

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

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3
Q

Hyperparathyroidism primary vs secondary

A
  1. Primary : high PTH + high Ca

2. Secondary : low PTH + high Ca

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4
Q

3 causes of Primary Hyperparathyroidism

A
  1. Adenoma
  2. Primary hyperplasia
  3. Parathyroid Carcinoma
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5
Q

Primary Hyperparathyroidism SX

A
  1. Bone pain (osteoporosis)
  2. Renal stones (Nephrolithiasis) , heart valve calcification
  3. ABD groans (C, gallstones)
  4. Psych moans (Depression…)
    Bones, stones, groans, moans
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6
Q

Osteitis Fibrosis Cystica

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

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

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7
Q

Primary Hyperparathyroidism in real world sx

A

None, just see high CA

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8
Q

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
A
  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
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9
Q

MEN 1 and parathyroid adenoma

1. Germline vs sporadic more common

A
  1. Somatic mutation (sporadic) = more common , germline (familial)
  2. Have to remove thyroid completely and parathyroid
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10
Q

Primary hyperplasia Parathyroid

  1. Can happen how
  2. Primary vs Secondary
  3. Histo
  4. TX
A
  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)
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11
Q

Parathyroid Carcioma parathyroid

  1. M/B
  2. Histo
  3. Another DX way to see this it happening
A
  1. Metastatic when dx
  2. Invasion of adjacent tissue + vascular invasion
  3. Adenoma was removed or parathyroids removed and PTH does not go down
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12
Q

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

A

Malignancy causing high CA

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

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13
Q

hypercalcemia with PTH low

  1. Hormone levels
  2. SX
A
  1. High CA, low PTH

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

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14
Q
  1. Asymptomatic hypercalcemia
  2. Symptomatic hypercalcemia
    What do you think
A
  1. Primary Hyperparathyroidism

2. Malignant Hypercalcemia

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15
Q

Malignant Hypercalcemia

3 MOA If happens and what types of cancer it involves

A
  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
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16
Q

Hypocalcemia SX

A
  1. Tetany (Chvosteks sign + Trousseau sign)
  2. Prolonged QT
  3. Muscle cramps
  4. Numbness paresthesia
17
Q

High PTH and low CA

Is called what and cause

A
  1. Secondary Hyperparathyroidism (reactive hyperplasia)

2. Renal disease causing dumping of CA + P resorption

18
Q

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

A
  1. Secondary Hyperparathyroidism** (usually) , can in primary Hyperparathyroidism
  2. Rugger jersey sign (bone eroding) vertebral bodies in middle hollowing out
19
Q

Calciphylaxis

  1. Consequence of what
  2. What happens
A
  1. Secondary hyperparathyroidism (usually due to renal disease)
  2. Extensive calcification and occlusion of BVs = ischemia, gangrene = die from infection/sepsis
20
Q

2 highs that happen in secondary hyperparathyroidism

A
  1. Calciphylaxis

2. Renal Osteodystrophy

21
Q

Tertiary hyperparathyroidism

A

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)

22
Q

Primary Hypoparathyroidism :

  1. Labs
  2. 5 causes
A

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
23
Q

DiGeorges syndrome

  1. Chr problem
  2. What happens in this
A
  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)
24
Q

Inactivated CASR (loss of function mutation)

  1. What happens
  2. Casing
  3. Contain it is called
A
  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
25
Q

Activated CASR (gain of function mutation)

  1. What happens
  2. Casing
  3. Contain it is called
A
  1. CA receptors in parathyroid think there is ALWAYS enough CA
  2. Hypocalcemia from low PTH secretion and high renal excretion
  3. AD hypoPTH
26
Q

Pseudohypoparathyriodism

  1. Hormone levels
  2. What happens
  3. You seen this in association with what usually
A
  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
27
Q

Albrights Hereditary Osteodystrophy SX

A
  1. Short stature + obese
  2. Short phalanges, of upper extremities
  3. Short phalanges of lower extremities
    + dental probs, subQ ossification, cataracts + seizures + tetany
28
Q

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

A

HIGH PTH, high CA

= probable parathyroid mass

ENRP Exam 2 (8 decks)

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