parathyroidism Flashcards
classification of hyperparathyroidism
- over production
- compensatory mechanism due to chronic hypocalcemia
- extopic production - due to long stand-ing cases of chronic hypocalemia that even if you correct it it will persists
what tumour is associtaed with hyperparathyroidism
brown tumour due to increase in clasts
signs/complications of hypercalcemia
osteoporosis stones keratopathy - corneal depostion CALLED BAND KERATOPATHY - slit lamp hypertension- diastolic /cardiac arrythmias nephrogenic DI
mones groans stones and psychiatric
abdominal groans- gi constiaption N& v
Painful bones- pseudo gout
Psychiatric Moans – Effects on nervous system: lethargy, fatigue, memory loss, psychosis, depression
muscles: ache, biopsy will show atrophy of myofibrils esp type 2
Neuropathy can be established on electromyography.
heart - Brady
short qt interval
poyuria (if diabetes insipidus0
severe cases:
bone cysts- can see on x ray
marrow fibrosis
fractures due to osteopeoprois due to deminierlaization
‘salt and pepper’ due to extensive areas of demineralization
calcifications of soft tissue- very high and can go to skin causing prurtits
brown tumour -highly vascularised with cuts
IS CKD associated with hypercalcemia or hyo
hypo
pseudoparathyrodism and constellation
body fails to respond to the hormone pth so production is fine. divided into type 1a and typs 2b
normal/low ca but high PTH and high P
Pseudopseduo
Patient has the phenotypic appearance of pseudo but has normal values
all brights hereditary osteodystrophy
falls under pseudoparathyrodism - short neck, bradydactyly round face
function of PTH
increase calcium levels via osteoclasts and kidneys and effect on the gut is INDIRECT via 1, 25 oH
ROLE OF 1,25(ОН)2D3
The principle physiologic role of 1,25(ОН)2D3 is to increase plasma levels of Ca and P and thus to maintain conditions favorable for bone mineralization.
now here we are talking about the GUT!!!
MECHANIS FOR INCREASING CALCIUM VIA PTH
⇓ Са → ⇑ secretion of PTH and ⇓ secretion of calcitonin;
This leads to ⇑ bone resorption, ⇓ renal excretion and ⇑ intestinal absorption of Са (via enhanced 1,25(ОН)2D3 production);
causes of primary hyperparathyroidism
- an adenoma of 1 gland - majority (usually in the inferior segment)
2 .hyperplasia of the glands
3.carcinoma - MEN TYPE 1
effect of calcium on kidneys
tubular+ peritubualar changes mainly distal+henle - calcifications
partial nephrogenic DI
stones - due to hypercalcuria and hyperohospaturia
nephrolithiasis and in 2% - NEPHROCALCINOSIS CAN OCCUR
brown tumour
The brown tumor is a bone lesion that arises in settings of excess osteoclast activity, such as hyperparathyroidism. They are a form of osteitis fibrosa cystica. It is not a neoplasm, but rather simply a mass. It most commonly affects the maxilla and mandible, though any bone may be affected.
GI features
sialoliathiasis gastric stimulation increased so peptic ulcer increase NASEUA, VOMITING , CONSTIPATION CHOLELIATHIASIS more common chronic pancreatitis?
ectopic hyperparathyroidism
also called psudohyperthyrodims associated with tumours - lung ca, breast ca
Acute hyperparathyroidism:
Due to hemorrhage or necrosis of the parathyroid adenoma. but can also be seen in non neoplasm states like dehydration and diuretic overuse
A large quantity of PTH enters the circulation and leads to rapid excessive increase of calcium level (above 3.5-4 mmol/l).
normal calcium levels
2.12-2.62 mol
signs of acute
strongly ensembles vitamin d toxicity
first VOMITTING + polyuria followed by dehrdayion, signs of AKI- oligoruia, acidosis
diagnosis of primary hyperthyroidism
urinary camp
and serves for differentiation between hyperparathyroidism and pseudohyperparathyroidism
1-25(ОН)2D level is increased, because PTH stimulates 1α-hydroxylase in the kidneys
Hyperchloremic acidosis is typical for the primary hyperparathyroidism, while other hypercalcemic conditions are characterized with metabolic alkalosis with lower chloride concentration.
tx of acute hypercalmceia
- calcitonin
- biphosphanates
- dialysis
- CS - increase excretion
- diuertics
cincalcet
used to treat high levels of PTH
esp in patients with chronic renal failure who are on dialysis
also fpr parathyoid cancee
