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Endocrine > Parathyroidism > Flashcards

Parathyroidism Flashcards

1
Q

What 3 things have an effect on calcium balance in the body?

What of them causes an increase and what causes a decrease?

A

Increase

  • PTH
  • Vit D (calcitriol)

Decrease
- calcitonin

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2
Q

What is the name of the G-coupled receptor found on parathyroid cells that helps to regulate calcium levels?

What is the name of the cell which this is found on?

A

Calcium-sensing receptor

Chief cells (in parathyroid) -> produce PTH

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3
Q

What 3 ways does PTH work to increase extracellular calcium levels?

A

Bone
- Increased bone breakdown (by increasing number of osteoclasts)

Gut
- Vit D activation -> Ca2+ absorption in gut

Renal

  • Increase in phosphaturia (phosphate in urine)
  • Increase Ca2+ absorption from urine
  • Activates Vit D into calcitriol
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4
Q

What is the typical presentation of hypercalceamia?

A

Bones (boney pain + muscle weakness)
Stones (kidney stones)
Abdominal groans (constipation)
Psychic moans (depression + confusion)

(+thrones - polyuria)

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5
Q

Name 3 complications of hyperparathyroidism

A

Osteoporosis
Renal stones
Bone disease - “brown tumours”

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6
Q

Describe the differences in levels of PTH and serum calcium in primary, secondary and tertiary hyperparathyroidism

A

All high PTH

Primary - high Ca2+
Secondary - low Ca2+
Tertiary - normal/high Ca2+

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7
Q

If a patient presents with high PTH and ALP. What should be screened for?

A

Bone malignancy - isotope bone scan

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8
Q

What genetic condition is associated with hyperparathyroidism?

A

MEN

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9
Q

What is the difference in causes between primary, secondary and teritary hyperparathyroidism?

A

Primary - caused by commonly parathyroid adenoma NOT hyperplasia

Secondary - caused commonly by chronic renal disease/vit D deficiency

Tertiary - caused by years of CKD -> PTH released independent of calcium levels

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10
Q

Explain in detail how secondary/tertiary hyperparathyroidism works

A

CKD

  • leads to reduced phosphate being excreted in urine -> increase phosphate in blood -> increased phosphate binding to calcium -> less avaliable calcium
  • leads to decreased calcium reabsorption

Vit D deficency -> reduced calcitriol -> reduced gut Ca2+ reabsorption

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11
Q

What kind of hyperparathyroidism also presents with osmotic symptoms?

A

Primary

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12
Q

How is hyperparathyroidism diagnosed?

What single test can be used to diagnose primary?

A

Blood tests

Calcium urine levels will be high

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13
Q

How is primary hyperparathyroidism managed?

A

Surgery

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14
Q

How is secondary hyperparathyroidism managed?

A

Renal transplant
Bisphosphonates
? Vit D analogue

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15
Q

What is the MoA of bisphosphonates?

A

Prevent osteoclast action -> protect bone from osteoporosis

also reduce Ca2+ levels - used in secondary for bone protection

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16
Q

How is acute hypercalcaemia managed?

A

Fluids

Biphosphonates

17
Q

What is the differnce in the phosphate serum levels in primary and secondary hyperparathyroidism?

A

Primary - low phosphate

Secondary - high phosphate (think phosphate binds to calcium)

18
Q

When is surgery indicated in primary hyperparathyroidism?

A

If causing complications

19
Q

What ECG abnormalities can be seen in hypocalcaemia?

A

Prolonged QT

20
Q

What are two clinical signs of hypocalcemia?

A

Chvostek’s sign
- when tap anterior to ear -> face twinges

Trousseau’s sign

  • BP cuff occludes brachial artery
  • hand and wrist flex

(trousseau is a type of cloth used in wedding dresses - imagine someone asking to marry you and they have your hand and hand and wrist flex away)

21
Q

What is the most common cause of hypoparathyroidism?

A

Post-operative removal

22
Q

What are the calcium levels like in hypoparathyroidism?

A

Low

23
Q

How is hypoparathyroidism managed?

A

Supplements

  • Vit D
  • Ca2+
24
Q

What genetic disorder is associated with absence of parathyroid?

A

DiGeorge syndrome

25
Q

What are the symptoms of hypocalcaemia?

A
  • Parasthetisa of distal digits and lips
  • tetany (involuntary contraction) of muscles
  • muscle weakness
  • seizures
  • prolonged QT
26
Q

How is acute hypocalcaemia (<2) managed?

Why is it an emergency?

A

EMERGENCY
- IV calcium gluconate

Low calcium can lead to cardiac arrhythmias and tetany of muscles inc. those in resp. pathway -> resp distress

27
Q

What other electrolyte should be tested for in a patient with low Ca2+?

A

Mg

Ca2+ release from cells is dependant on Mg
Low Mg = low Ca2+ release

28
Q

If someone has low Ca2+ due to low Mg+ how should they be managed?

A

Replace both magnesium and calcium

29
Q

A patient presenting from mild hypocalcaemia (>2) how should they initially be managed following parathyroidetomy?

A

Observe - very common following initial surgery

30
Q

What is the more common cause of primary hyperparathyroidism. Parathyroid adenoma or hyperplasia?

A

Adenoma

Endocrine (23 decks)

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