Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ENRP Exam II > Parathyroid Pathology (Hillard) > Flashcards

Parathyroid Pathology (Hillard) Flashcards

1
Q

embryology of parathyroid gland

A

superior parathyroid - 4th pharyngeal pouch
inferior parathyroid - 3rd pharyngeal pouch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Chief cells

A

produce parathyroid hormone (PTH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

CaSR mechanism

A

Calcium-sensing receptor (Gi) present on parathyroid chief cells; binds calcium and inhibits PTH release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 3 possible causes of primary hyperparathyroidism?

A

Parathyroid adenoma (95%)
Parathyroid hyperplasia (5%)
Parathyroid carcinoma (rare)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Parathyroid adenoma

A

benign; typically affects a single gland; 1/3 are due to sporadic MEN 1 mutations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Parathyroid hyperplasia

A

enlargement of all 4 glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Parathyroid carcinoma

A

malignant; usually large; features of malignancy:
vascular invasion
invasion of adjacent structures/organs
metastasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Clinical presentation of primary hyperparathyroidism

A

usually asymptomatic and picked up by routine calcium screening; when symptomatic “Bones, Stones, Abd Groans and Psychic Moans”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hyperparathyroidism effects on bone

A

osteoporosis
Osteitis fibrosis cystica - cystic brown tumors, bone cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Parathyroid disease work-up

A

imaging studies; sestamibi scintigraphy and SPECT -single photon emission computed tomography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the most reliable feature to distinguish parathyroid adenoma vs hyperplasia

A

number of glands involved
adenoma: one gland
hyperplasia: all 4 are involved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Treatment of parathyroid adenoma and hyperplasia

A

surgical resection for both
adenoma excision and 3 1/2 glands removed in hyperplasia (if de-vascularized put remaining 1/2 in forearm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Most common cause of secondary hyperparathyroidism

A

renal failure; decreased production of calcitriol; decreased phosphate excretion (HYPERphosphatemia) binding to free Ca2+; resulting in hypocalcemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

secondary hyperparathyroidism

A

prolonged hypocalcemia causes compensatory PTH release; expect to see parathyroid hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Secondary hyperparathyroidism of renal failure

A

Renal osteodystrophy - bone pain and fractures
Calciphylaxis - vessel calcifications causing vascular compromise, necrosis of skin; associated w/ HYPERphosphatemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Calciphylaxis

A

seen in secondary hyperparathyroidism of renal failure; vessel calcifications causing vascular compromise, necrosis of skin; associated w/ HYPERphosphatemia

17
Q

Tertiary hyperparathyroidism

A

persistent secretion of PTH after long-standing secondary hyperparathyroidism; usually due to chronic renal failure or end-stage renal disease

18
Q

Hypercalcemia of malignancy

A

tumor secretion of PTH-related peptide (PTHrP); neoplastic phenomenom

19
Q

Hypercalcemia in sarcoidosis

A

non-caseating granulomatous disease; bilateral hilar lymphadenopathy; hypercalcemia caused by increased 1-alpha hydroxylase in macrophages creates calcitriol (activated Vit. D)

20
Q

Cause of hypercalcemia in sarcoidosis

A

increased 1-alpha hydroxylase in macrophages creates calcitriol (activated Vit. D)

21
Q

Major causes of hypoparathyroidism

A

Acquired: surgical mistake or autoimmune APS-1 mut
Congenital: DiGeorge, AD hypoparathyroidism or familial isolated hypoparathyroidism

**both PTH and Ca2+ are low

22
Q

Chvostek sign

A

finding in hypoparathyroidism; tapping of facial nerve causes contraction of muscles

23
Q

Trousseau sign

A

finding in hypoparathyroidism; carpal spasm w/ occlusion of arm w/ BP cuff

24
Q

Findings in hypocalcemia

A

Tetany - paresthesias, spasms and seizures
Chvostek sign
Trousseau sign

25
Q

DiGeorge Syndrome

A

CATCH-22
deletion of chr 22q11
pharyngeal pouch development issue, underdeveloped parathyroid gland, decreased PTH, decreased Ca2+

26
Q

Autosomal Dominant hypoparathyroidism

A

GOF mut in CASR gene; increase sensitivity to Ca2+; PTH is inhibited; low PTH and low Ca2+

27
Q

Pseudohypoparathyroidism

A

presents in childhood, end-organ resistance to PTH due to mutation in G protein receptor; low Ca2+ despite elevated PTH; resistance to other anterior pituitary hormones as well; Albright Hereditary Osteodystrophy

28
Q

Albright Hereditary Osteodystrophy

A

Pseudohypoparathyroidism; presents in childhood, end-organ resistance to PTH due to mutation in G protein receptor; low Ca2+ despite elevated PTH; resistance to other anterior pituitary hormones as well

29
Q

MEN 1

A

“PPP”
Pituitary adenoma
Parathyroid adenoma/hyperplasia
Pancreatic endocrine tumors
and duodenal gastrinoma

30
Q

MEN 2A

A

“PM Pheo”
Parathyroid hyperplasia
Medullary thyroid carcinoma
Pheochromocytoma

31
Q

MEN 2B

A

“MMM Pheo”; germline missense mut in RET
Mucosal neuromas
Marfanoid body
Medullary thyroid carcinoma
Pheochromocytoma

**no involvement with parathyroid unlike MEN2A

32
Q

MEN 4

A

Pituitary and parathyroid (similar to MEN 1)

33
Q

Wermer syndrome

A

MEN 1 (tumor suppressor) mut; “PPP”

Pituitary adenoma - PRL (galactorrhea and amenorrhea)

Parathyroid adenoma/hyperplasia (bones, stones, abd groans and psychiatric moans”

Pancreatic endocrine tumors - insulinoma (hypoglycemia)

and duodenal gastrinoma - Zollinger-Ellison syndrome

34
Q

Zollinger-Ellison syndrome is associated with which MEN disorder?

A

MEN 1 AKA Wermer syndrome; “PPP”
Pituitary adenoma
Parathyroid adenoma/hyperplasia
Pancreatic endocrine tumors
and duodenal gastrinoma

35
Q

Testing for suspected MEN 1

A

DNA testing

36
Q

Sipple Syndrome

A

MEN 2A; GOF RET proto-oncogene; “PM Pheo”

Parathyroid hyperplasia

Medullary thyroid carcinoma - C cell hyperplasia (calcitonin)

Pheochromocytoma

37
Q

Gain of function RET proto-oncogene is seen in which MEN disorder?

A

Sipple Syndrome; MEN 2A; “PM Pheo”

Parathyroid hyperplasia

Medullary thyroid carcinoma - C cell hyperplasia (calcitonin)

Pheochromocytoma

38
Q

Germline missense mut in RET is seen in which MET disorder?

A

MEN 2B; “MMM Pheo”;
Mucosal neuromas
Marfanoid body
Medullary thyroid carcinoma
Pheochromocytoma

**no involvement with parathyroid unlike MEN2A

ENRP Exam II (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions