Parathyroid Surgical Disease

Question 1

Parathyroid hormone half life:

Answer 1

2-4 minutes

Question 2

Inc PTH—>

Answer 2

Inc calcium
Dec phosphate

Question 3

When calcitonin increases:

Answer 3

Decrease calcium
Decrease phosphate

Question 4

When vitamin D increases

Answer 4

Calcium increase
Phosphate increase

Question 5

Chronic renal failure is associated with which hyperparathyroidism?

Answer 5

Secondary hyperparathyroidism

Question 6

Definition of primary hyperparathyroidism

Answer 6

“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

Question 7

What is MEN syndrome

Answer 7

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

Question 8

Tertiary hyperparathyroidism

Answer 8

+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.)

Question 9

If PHPT is associated with MEN syndrome causes

Answer 9

Hyperplasia

Question 10

Alkaline phosphatase increase shows

Answer 10

Hungry bone syndrome during PHPT

Question 11

Diagnosis method for ECTOPIC localization primary hyperparathyroidism

Answer 11

SPECT-MIBI

Question 12

What are the symptoms of PHPT

Answer 12

-Kidney stones( due to calcification)
-Polyuria, polydipsia, nocturia
-Abdominal pain (due to pancreatitis, cholylithiasis, Peptic ulcers)
-Hypertension
-Bone pain
-Depression
-Fatigue
-decreased apetite

Question 13

To whom do you perform parathyroidectomy?

Answer 13

Under age of 50yrs
Patients with complications /symptoms

Question 14

What are the surgical indications in asymptomatic hyperparathyroidism

Answer 14

Age<50 yrs old

Significant increase in calcium(8.5-10.5)

GFR<60

Life threatening hypercalcemic episode

Question 15

What is parathyroid carcinoma symptoms?

Answer 15

Ca lvls above 14

PTH LVLS 5x than normal

Palpable parathyroid gland

Question 16

Persistent vs recurrent hyperparathyroidism, what is the difference?

Answer 16

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).

Question 17

Indications for surgery in secondary hyperparathyroidism

Answer 17

*itching
Bone pain
* calcium x phosphate >or equal to 70
Calcium lvl >11mg/dl

Question 18

When are calcium PTH and phosphorus all increase at the same time?

Answer 18

In tertiary hyperparathyroidism

Question 19

Tingling feeling in lips &finger tips and purple lips are signs of?

Answer 19

Hypoparathyroidism

Question 20

what are the 2 signs that indicate hypocalcemia in hypoparathyroidism?

Answer 20

chvostek’s sign and Trousseu’s sign

Question 21

what are chvostek’s sign and Trousseu’s sign?

Answer 21

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.

Question 22

what is the most common cause of Persistent and recurrent hyperparathyroidism,

Answer 22

ectopic parathyroids

Question 23

what is the tx for secondary hyperparathyroidism?

Answer 23

low phosphate diet, tx of chronic kidney disease, and ergocalciferol (tx of vit D deficiency)

Question 24

what are the features of patients with secondary hyperparathyroidism ?

Answer 24

hyperparathyroidemia, hypocalcemic[or normocalcemia] and hyperphosphatemic

Question 25

what is the causes of secondary HPT?

Answer 25

chronic renal failure [and low vitamin D]

Question 26

what are the features of patients with tertiary hyperparathyroidism ?

Answer 26

PTH, Calcium, and Phosphorus(can be normal) ALLL are high

Question 27

when is surgical intervention is applied for patients with hyperparathyroidism?

Answer 27

if they are symptomatic and
if they are <50 yrs old

Question 28

what are the causes of hypocalcemia?

Answer 28

-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]

Question 29

what is the cell that secretes PTH hormone [and pepsinogen]?

Answer 29

chief cells (found in parathyroid gland)

Question 30

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?

Answer 30

oxyphil cells (found in parathyroid gland)

Question 31

80% of PHPT is …..?

Answer 31

Sporadic (occurs irregularly in ppl)

Question 32

**What is the most common cause of PHPT?

Answer 32

-Adenoma(80% solitary); MEN1&MEN2A
-hyperplasia
-carcinoma

Question 33

**What are the features of Hungry bone syndrome?

Answer 33

PTH inc
Ca2+ inc
Phosphorus dec
ALP(alkaline phosphate) inc**

Question 34

**What is the most common ectopic localization of PHPT?

Answer 34

Intrathyroidal11% Transesophageal28% ;detected by SPECT MIBI

Question 35

**What is the diagnostic method used to detect parathyroid adenomas in PHPT?

Answer 35

Technetium 99m sestamibi (MIBI) scintigraphy