Parathyroid triggers

Question 1

what are CaSRs and what is their function

Answer 1

Calcium sensing receptors in the parathyroid and kidneys
they sense calcium and suppress parathyroid secretion and decrease the amount of Ca reabsorbed in the kidneys

Question 2

if we have a urine calcium of 250 what ddx can we rule out

Answer 2

Familial Hypocalciuric hypercalcemia

(this is ruled out over 200)

Question 3

med indicated only in severe hypocalcemia

Answer 3

calcium gluconate

Question 4

Single parathyroid adenoma

Answer 4

MCC of yperparathyroidism

Question 5

Raloxifene

Answer 5

estrogen replacement medication used in post-menopausal women who have hypercalcemia

Question 6

agonist in bone, antagonist in breast/uterine tissues

Answer 6

raloxifene

Question 7

tetany

Answer 7

acute hypocalcemia

Question 8

high requirements of Vitamin D2 specifically

Answer 8

hypoparathyroidism

Question 9

Chvostek’s and Trosseau’s

Answer 9

signs of hypocalcemia
Chvosteks (twitch when tapping cheek)
Trosseaus (curling of hand w BP cuff)

Question 10

elevated PTH = definitive diagnostic

Answer 10

PHPT

Question 11

what lab finding increases with the size of a parathyroid adenoma

Answer 11

PTH

Question 12

Differentiating between PHPT and SHPT uses what study

Answer 12

Serum Phosphate
low in PHPT
high in SHPT

Question 13

Oral calcium
Vit D supplements

Answer 13

Maintenance therapy for hypoparathyroidism
Also use:
Monitor Mg
use teriparatide if refractory

Question 14

Monitor Mg
use teriparatide if refractory

Answer 14

maintenance therapy for hypoparathyroidism
also use:
Oral calcium
Vit D supplements

Question 15

can be used in acute hypocalcemia d/t hypoparathyroidism or in secondary hyperparathyroidism in CKD

Answer 15

calcitriol

Question 16

High serum phosphate suggests

Answer 16

hypoparathyroidism or secondary hyperparathyroidism

Question 17

IV NS over 4 hrs
furosemide +/-
corticosteroids +/-

hemodialysis if extremely severe

Answer 17

treating severe hypercalcemia

Question 18

diarrhea and GI irritation

Answer 18

adverse events of MgO supplementation

Question 19

bones, stones, moans, groans

Answer 19

Hypercalcemia

Question 20

nuclear scan used when

Answer 20

to check to see which tissue is hyperfunctioning

Question 21

Neck US used when

Answer 21

only if surgery is being considered

Question 22

CT-4D scan is used when

Answer 22

only if other scans are negative.

Question 23

V-D 25

Answer 23

inactive form of Vitamin D-1,25

Question 24

1,25-dihydroxy-Vit D

Answer 24

calcitriol aka active form of Vit D

Question 25

hyperparathyroidism and malignancy

Answer 25

two MCC of hypercalcemia

Question 26

hypercalcemia triggers

Answer 26

release of caclitonin

Question 27

osteopenia/osteoporosis

Answer 27

complication of PHPTH

Question 28

vitamin D def is a complication of

Answer 28

PHPT

Question 29

nephrolithiasis

Answer 29

common in PHPTH

Question 30

Tissue injury

Answer 30

cause of secondary hyperparathyroidism

Question 31

cinacelcet

Answer 31

managing symptomatic PHPT
also managing symptomatic PHPT

Question 32

Oral/IV bisphosphonates

Answer 32

managing symptomatic PHPT
also cinacalcet

Question 33

CaSR binder to decrease PTH secretion

Answer 33

Cinacalcet

Question 34

cannot treat hypercalcemia/uria

Answer 34

oral Bisphosphinates

Question 35

can temporarily treat hypercalcemia

Answer 35

IV bisphosphonates

Question 36

5X ULN of PTH indicates

Answer 36

parathyroid carcinoma

Question 37

What is the acute management protocol for hypoparathyroidism?

Answer 37

AIRWAY
IV Calcium gluconate
Oral Calcium
Magnesium (if hypomagnesemic)
Mg oxide after IV
Vit D therapy once oral calcium is started. (Calcitriol preferred)

Question 38

indicated for hypocalcemia prevention/treatment
ALSO
for primary osteoporosis prevention

Answer 38

calcium carbonate

Question 39

severe: spasms and seizreus

Answer 39

hypocalcemia

Question 40

prolonged QT

Answer 40

hypocalcemia

Question 41

short QT, hypotension, bradycardia

Answer 41

hypercalcemia

Question 42

initial labs include PTH, albumin, creatinine, phosphorus, Mg, vit D

Answer 42

hypocalcemia

Question 43

initial labs include PTH, Ca, phosphorus, Vit D, and BUN/Cr

Answer 43

secondary Hyperparathyroidism

Question 44

enhances effect of PTH on bone

Answer 44

Vit D - 1,25

Question 45

increases intestinal absorption of Ca and phorphorus

Answer 45

Vit D-1,25 plus PTH!

Question 46

usually asymptomatic unless found on labs or extremely severe

Answer 46

PHPT

Question 47

suppresses renal absorbtion of Ca

Answer 47

calcitonin

Question 48

inhibits osteoclastic activity of bones

Answer 48

calcitonin

Question 49

What labs and imaging can we order to monitor asymptomatic PHPT?

Answer 49

Serum Ca and Albumin 2x/yr
Renal function and urine calcium 1x/yr
Serum Vit D 25
3 site DEXA scan (distal radius, hip, and spine) every 2 yrs.

Question 50

T wave abnormalities

Answer 50

hypoparathyroidism

Question 51

Vit D from plants

Answer 51

Vit D 2 (ERGO)

Question 52

Vit D from sun/synthesized in epidermis

Answer 52

Vit D3 (CHOLE)

Question 53

what does PTHrP do?

Answer 53

enhances effect of PTH on bone and kidneys
normally found in body but also secreted by cancer cells

Question 54

what should a pt with PHPT avoiud

Answer 54

Avoid:
* Thiazides
* Large Vit A doses
* Calcium antacids

Question 55

what are ways a patient w PHPT can decrease/manage symptoms

Answer 55

Regular WEIGHT-bearing exercises
Avoid immobilization
Drinking adequate fluids.

Question 56

job of calcitonin

Answer 56

oppose PTH