Parathyroid Surgical Disease Flashcards
Parathyroid hormone half life:
2-4 minutes
Inc PTH—>
Inc calcium
Dec phosphate
When calcitonin increases:
Decrease calcium
Decrease phosphate
When vitamin D increases
Calcium increase
Phosphate increase
Chronic renal failure is associated with which hyperparathyroidism?
Secondary hyperparathyroidism
Definition of primary hyperparathyroidism
“Malfunctioning” of the gland;
bcz of the disruption of the normal feedback control of serum calcium, the result is an increased PTH production in the parathyroid glands
What is MEN syndrome
MEN 1 and MEN2A both cause parathyroid hyperplasia;’
in MEN1 there’s over secretion of PTH which leads to bone break down then HYPERCALCEMIA then calcium kidney stones
Tertiary hyperparathyroidism
+characterized by excessive secretion of PTH after longstanding secondary hyperparathyroidism. in which hypercalcemia has ensued.
+Tertiary HPTH typically occurs in men and women with chronic kidney disease usually after kidney transplant.
seen in patients with renal failure who have undergone successful kidney transplantation. (Patients gained autonomy from the parathyroid gland.)
If PHPT is associated with MEN syndrome causes
Hyperplasia
Alkaline phosphatase increase shows
Hungry bone syndrome during PHPT
Diagnosis method for ECTOPIC localization primary hyperparathyroidism
SPECT-MIBI
What are the symptoms of PHPT
-Kidney stones( due to calcification)
-Polyuria, polydipsia, nocturia
-Abdominal pain (due to pancreatitis, cholylithiasis, Peptic ulcers)
-Hypertension
-Bone pain
-Depression
-Fatigue
-decreased apetite
To whom do you perform parathyroidectomy?
Under age of 50yrs
Patients with complications /symptoms
What are the surgical indications in asymptomatic hyperparathyroidism
Age<50 yrs old
Significant increase in calcium(8.5-10.5)
GFR<60
Life threatening hypercalcemic episode
What is parathyroid carcinoma symptoms?
Ca lvls above 14
PTH LVLS 5x than normal
Palpable parathyroid gland
Persistent vs recurrent hyperparathyroidism, what is the difference?
Persistent HPT (perHPT) is defined as persistence of hypercalcemia after parathyroidectomy
or
recurrence of hypercalcemia within the first 6 months, and recurrence of hypercalcemia after a normocalcemic period of more than 6 months is defined as recurrent HPT (recHPT).
Indications for surgery in secondary hyperparathyroidism
*itching
Bone pain
* calcium x phosphate >or equal to 70
Calcium lvl >11mg/dl
When are calcium PTH and phosphorus all increase at the same time?
In tertiary hyperparathyroidism
Tingling feeling in lips &finger tips and purple lips are signs of?
Hypoparathyroidism
what are the 2 signs that indicate hypocalcemia in hypoparathyroidism?
chvostek’s sign and Trousseu’s sign
what are chvostek’s sign and Trousseu’s sign?
Chvostek’s and Trousseau’s signs are both indicators of low calcium, but they manifest differently.
+Chvostek’s sign is seen in the face when facial muscles twitch after the facial nerve is tapped lightly on the upper cheek, (just in front of the ear). This is caused by increased neuromuscular excitability.
+=Trousseau’s sign occurs with the contraction of the muscles in the hand and wrist (i.e., carpopedal spasm). This is seen after you put a blood pressure cuff on a client.
what is the most common cause of Persistent and recurrent hyperparathyroidism,
ectopic parathyroids
what is the tx for secondary hyperparathyroidism?
low phosphate diet, tx of chronic kidney disease, and ergocalciferol (tx of vit D deficiency)
what are the features of patients with secondary hyperparathyroidism ?
hyperparathyroidemia, hypocalcemic[or normocalcemia] and hyperphosphatemic
what is the causes of secondary HPT?
chronic renal failure [and low vitamin D]
what are the features of patients with tertiary hyperparathyroidism ?
PTH, Calcium, and Phosphorus(can be normal) ALLL are high
when is surgical intervention is applied for patients with hyperparathyroidism?
if they are symptomatic and
if they are <50 yrs old
what are the causes of hypocalcemia?
-hypoparathyroidism(due to surgery)
-kidney transplant ischemia
-resistance to PTH
-pseudohypoparathyroidism
-renal insufficiency
-drugs(calcitonin)
-insufficient production of 1,25 dihydroxy vit.D
-resistance to 1,25 dihydroxy vit.D activity
[+FLAT AIR LEVEL+MECHANICAL OBSTRUCTION+ ileus electrolyte IMBALANCE]
what is the cell that secretes PTH hormone [and pepsinogen]?
chief cells (found in parathyroid gland)
what is the cell that, has unknown function, but it secretes factors s.a parathyroid hormone-related protein and calcitriol[inc amount of calcium] that stimulate PTH?
oxyphil cells (found in parathyroid gland)
80% of PHPT is …..?
Sporadic (occurs irregularly in ppl)
**What is the most common cause of PHPT?
-Adenoma(80% solitary); MEN1&MEN2A
-hyperplasia
-carcinoma
**What are the features of Hungry bone syndrome?
PTH inc
Ca2+ inc
Phosphorus dec
ALP(alkaline phosphate) inc**
**What is the most common ectopic localization of PHPT?
Intrathyroidal11% Transesophageal28% ;detected by SPECT MIBI
**What is the diagnostic method used to detect parathyroid adenomas in PHPT?
Technetium 99m sestamibi (MIBI) scintigraphy
