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N935 Advanced Pathophysiology II > Parathyroid Pathophysiology > Flashcards

Parathyroid Pathophysiology Flashcards

1
Q

how many parathyroid glands are there?

A

4

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2
Q

PTH

A
  • parathyroid hormone, parathormone
  • released into the bloodstream by negative feedback mechanism
  • depended on plasma calcium concentration
  • half-life is 4 min
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3
Q

avg PTH level

A

8-51 pg/mL

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4
Q

hypocalcemia

A

release parathormone

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5
Q

hypercalcemia

A

suppress synthesis and release of parathormone

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6
Q

function of PTH

A

maintains normal plasma calcium concentration

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7
Q

what three interfaces does calcium move across

A
  • GI tract
  • renal tubules
  • bone
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8
Q

resorption

A
  • in context of physiology is absorption into the circulation
  • osteoclasts break down the bone tissue and release minerals, resulting in transfer of calcium from bone tissue to the blood
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9
Q

osteoclasts

A
  • found on surface of bones and are multi-nucleated cells that contain numerous mitochondria and lysosomes
  • break down bone tissue by digestion and degradation
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10
Q

calcitonin

A
  • opposes effects of PTH
  • secreted by parafollicular cells in thyroid
  • secretion stimulated by hypercalcemia
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11
Q

PTH three ways of raising blood calcium

A
  • bone resorption by osteoclasts
  • increased calcium reabsorption by kidneys (and decreased phosphate reabsorption)
  • increased calcium reabsoprtion by intestines
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12
Q

3 ways calcitonin lowers blood calcium

A
  • inhibits osteoclast activity in bones
  • inhibits renal tubular cell reabsorption of Ca2+
  • inhibits Ca2+ absorption in the intestines
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13
Q

vitamin D

A
  • fat soluble
  • increases intestinal absorption of calcium, mag, and phos
  • contributes to calcium homestasis and metabolism
  • vitamin D receptors located in the intestines, kidneys, bone, and parathyroid gland
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14
Q

vitamin D receptors functions

A
  • helps transport proteins absorb calcium in intestine
  • bone resorption
  • reabsorption of calcium in distal nephron
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15
Q

normal total calcium level

A
  • includes bound and free

- 9.5-10.5 mg/dL

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16
Q

normal iCal

A

4.75-5.7 mg/dL

free calcium

17
Q

calcium in the body

A
  • 50% bound to albumin
  • 40% ionized
  • 10% bound to chelating agents
18
Q

acidosis and serum calcium

A

increases serum calcium
protein binding decreases as pH decreases
increased ionized fraction

19
Q

alkalosis and serum calcium

A

decreases serum calcium

decreased ionized fraction

20
Q

how much does calcium increase with each 0.1 decrease in pH?

A

0.05 mmol/L

21
Q

biological functions of calcium

A
  • bone formation
  • reservoir for ECF
  • blood clotting
  • excitability of nerve and muscle
  • metabolic regulation for action of hormones and enzyme activation
22
Q

disorders r/t PTH

A
  • reduced production of PTH - DiGeorge, CATCH 22, autoimmune
  • impaired PTH due to peripheral resistance
  • parathyroid gland adenomas
23
Q

hyperparathyroidism

A
  • excess production of PTH
  • most common cause of hypercalcemia defined as total serum calcium above 10.4
  • classifications = primary, secondary, ectopic
24
Q

primary hyperparathyroidism causes

A
  • benign adenoma (80-90%)
  • hyperplasia
  • carcinoma
25
Q

s/s hyperparathyroid

A
  • involve kidneys and skeletal system
  • calcium deposits in renal parenchyma or recurrent nephrolithiasis
  • skeletal pathology
  • symptoms more common at calcium levels above 11.5-12
26
Q

diagnosis of hyperparathyroid

A
  • PTH assay
  • calcium level
  • vitamin D levels
  • renal function
  • CT scan
  • has anything happened to neck?
  • albumin?
27
Q

medical management of hyperparathyroid

A
  • used for mild, asymptomatic disease
  • mild hypercalcemia (12) –> hydration
  • moderate to severe hypercalcemia (13-15) –> IV saline hydration and furosemide to promote Na/Ca diuresis
28
Q

surgical management of hyperparathyroid

A
  • definitive treatment

- intraop PTH assay measured before and at 5 min intervals after adenoma removal to confirm a rapid fall to normal

29
Q

multiple gland hyperplasia treatment

A
  • three removed with partial excision of fourth (leaving a good blood supply)
  • total parathyroidectomy performed with immediate transplantation of a removed, minced parathyroid gland into the forearm muscles
30
Q

hypoparathyroidsim

A
  • absence or deficiency of PTH secretion
  • resistance of peripheral tissue to effects of hormone
  • iatrogenic (removed surgically with thyroidectomy)
  • result = hypocalcemia
31
Q

hypocalcemia s/s

A
  • neuronal irritability
  • skeletal muscle spasms
  • tetany (reduced calcium lowers threshold for depolarization)
  • seizures
  • fatigue and mental status changes
  • prolonged AT
  • CHF (chronic)
  • hypotension (acute)
  • chvostek’s sign
  • trousseau’s sign
32
Q

what can acute hypocalcemia present with?

A
  • stridor
  • laryngospasm
  • apnea
33
Q

hypocalcemia treatment

A
  • electrolyte replacement
  • calcium and vitamin D
  • hypomagnesemia managed with oral or IV replacement
  • severe requires 10-20 mL of 10% calcium gluconate OR 3-5 mL of 10% calcium chloride followed by a continuous infusion of calcium (1-2 mg/kg/h)
34
Q

anesthesia and hypocalcemia

A

-treat prior to elective surgery

35
Q

major anesthetic risks of hypocalcemia

A
  • decreased cardiac contractility
  • dysrhythmias
  • tetany
  • altered response to muscle relaxants
  • risk for laryngospasm
36
Q

overactive parathyroid gland

A
  • 1 in 100 people will develop parathyroid gland tumor
  • treatment = surgical removal
  • without treatment = fatigue, bad memory, kidney stones, osteoporosis
37
Q

anesthetic management of parathyroidectomy

A
  • concern for cardiac dysrhytmias secondary to elevated calcium
  • NIMs ETT (assess RLN)
  • effects of NMBDs unpredictable (consider qualitative NMB monitoring)
  • careful positioning (risk for fractures)
  • post op complications similar to thyroid
38
Q

post op complications of parathyroidectomy

A
  • RLN injury
  • hematoma
  • hypocalcemia
39
Q

PTH sampling during surgery

A
  • baseline PTH
  • scheduled PTH samples in OR at time 0 (removal of parathyroid as alerted by surgeron) AND time 5, 10, and 15 min post parathyroid removal

N935 Advanced Pathophysiology II (16 decks)

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