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Y2 Endocrine > Parathyroid: Science and Clinical > Flashcards

Parathyroid: Science and Clinical Flashcards

1
Q

Main effect of parathyroid hormone

A

raise the blood calcium

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2
Q

What are the 3 main ways PTH raises blood calcium?

A
  1. breaking down bone 2. increasing absorption of calcium from food 3. increasing the kidneys ability to hold onto calcium
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3
Q

7-dehydrocholesterol is converted by UV waves into ____________ or cholecalciferol

A

7-dehydrocholesterol is converted by UV waves into VITAMIN D3 or cholecalciferol

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4
Q

Where is cholecaliferol converted into calcidilol?

A

the liver

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5
Q

What is calcidilol?

A

25hydroxyVitamin D3

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6
Q

Where is 25hydroxyVitaminD3 activated?

A

the kidneys

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7
Q

What is 25hydroxyVitamin D3 converted into in the kidney?

A

1,25dihydroxyvitamin D3

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8
Q

What is 1,25dihydroxyvitamin D3 also known as?

A

calcitriol

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9
Q

Calcitriol acts on the ____ of the kidney to increase calcium absorption

A

PCT - proximal convoluted tubule

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10
Q

Calcitriol actis on the gut to…

A

increase calcium and phosphate absorption

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11
Q

Calcitriol acts on the bone to…

A

increase resorption of calcium and phosphate

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12
Q

Calcitriol acts on the parathyroid gland…

A

in a negative feedback manner - inhibiting further PTH release

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13
Q

PTH acts on the ____ of the kidney to increase calcium reabsorption

A

DCT - distal convoluted tubule

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14
Q

PTH acts on the bone to…

A

activate the osteoblasts which subsequently activate the pre-osteoclasts

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15
Q

osteoclasts are a form of….

A

macrophage - they respond to macrophage colony stimulating factor

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16
Q

Action of calcitonin

A

released in response to raised plasma calcium and has opposite effects to PTH

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17
Q

Calcitonin is released from…

A

the parafollicular cells of the thyroid gland

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18
Q

the majority of cases of primary hyperparathyroidism are caused by…

A

a solitary adenoma

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19
Q

Symptoms which may be associated with primary hyperparathyroidism

A

weak, tired, thirsty, dehydrated, polyuria, renal stones, abdominal pain, pancreatitis, duodenal (less gastric) ulcers, fractures, osteoporosis or osteopaenia, increase BP

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20
Q

What genetic condition is primary hyperparathyroidism associated with?

A

MEN 1

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21
Q

What are the 3 Ps associated with MEN 1?

A

Parathyroid hyperplasia, Pancreatic endocrine tumours, Pituitary tumour

22
Q

The MEN1 gene is a…

A

tumour suppressor gene

23
Q

Investigations for primary hyperparathyroidism

A

raised Ca, raised or normal PTH, decreased phosphate, increased Alk Phos, 24 hr urinary Ca, DEXA, X-ray, CT

24
Q

what should be avoided in primary hyperparathyroidism?

A

excess calcium and vitamin D intake, avoid thiazide diuretics

25
Q

Surgery is always indicated with primary hyperparathyroidism - TRUE/FALSE

A

FALSE - surgery is only indicated if there is end-organ damage

26
Q

Indications for surgery to treat hyperparathyroidism

A

bone disease, gastric ulcers, renal stones, osteoporosis, less than 50 years old, renal impairement (<60ml/min eGFR)

27
Q

Drug that can be used in tertiary and carcinoma hyperparathyroidism

A

cinacalet - increases the PT to increased calcium thus reducing the production of PTH

28
Q

Results from secondary hyperparathyroidism

A

decreased calcium and appropriately raised PTH

29
Q

Causes of secondary hyperparathyroidism

A

decreased Vit D intake and chronic renal failure

30
Q

Results of tertiary hyperparathyroidism

A

raised Ca and very raised PTH

31
Q

cause of tertiary hyperparathyroidism

A

prolonged secondary hyperparathryoidsim causes glands to start acting autonomously - chronic renal failure

32
Q

What is malignant hyperparathyroidism?

A

the release of PTH-related protein from some cancers

33
Q

Cancers associated with malignant hyperparathyroidism?

A

squamous cell lung cancer, breast and renal cell carcinomas

34
Q

results in malignant hyperparathyroidism

A

decreased PTH and raised Ca

35
Q

Brief causes of hypoparathyroidism

A

congenital absence, destruction, autoimmune, hypomagnesia, idiopathic

36
Q

Symptoms of hypocalcaemia

A

paraesthesia, muscle cramps, weakness, tetany, fatigue, bronchospasm, fits, Chovsteks sign, Trousseau sign, QT prolongation

37
Q

Acute hypocalcaemia is an emergency which is treated with…

A

IV calcium gluconate, 10ml, 10% over 10 mins in 50ml dextrose

38
Q

Long term management of hypocalcaemia

A

calcium supplement of 1-2g a day, Vit D tabs or depot injection

39
Q

Why is magnesium so important for calcium?

A

calcium release from cells is highly dependent on magnesium

40
Q

Causes of hypomagnesia

A

alcohol, drugs, GI illness, pancreatitis, malabsorption

41
Q

Drugs which may cause hypomagnesia

A

thiazides and PPIs

42
Q

Pseudohypoparathyroidism is…

A

a genetic defect in the GNAS1 gene

43
Q

Test results in pseudohypoparathyroidism

A

low Ca, high PTH - cells are PTH resistant

44
Q

what is pseudopseudohypoparathryoidism?

A

all of pseudohypoparathyroidism but with normal calcium

45
Q

Rickets and Osteomalacia are caused by…

A

vitamin D deficiency

46
Q

potential causes of vitamin D deficiency

A

gastric surgery, coeliac disease, liver disease, pancreatic failure, chronic renal failure, lack of sunlight, drugs i.e. anti-convulsants

47
Q

Clinical signs of vitamin D deficiency

A

low calcium, muscle wasting (proximally), dental defects (caries and enamel), bone tenderness with deformity, fractures or pseudofractures

48
Q

Blood results with osteomalacia

A

low Ca, low PO4, high Alk Phos, low Vit D, high PTH

49
Q

malignancy associated with long term vitamin D deficiency

A

colon

50
Q

Vitamin D3 tablets come in 2 forms which are…

A

calcitriol (1,25 Vit D3), alfacalcidilol (1a Vit D3)

Y2 Endocrine (4 decks)

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