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Endocrine > Parathyroids > Flashcards

Parathyroids Flashcards

1
Q

What mineral adds strength to bone?

A

Calcium phosphate

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2
Q

Most Ca is contained where?

A

Skeleton

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3
Q

PT glands are stimulated by:

A

Hypocalcaemia

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4
Q

Effects of PTH

A

Increased Oc resorption
Reabsorption of Ca in kidneys
Excretion of phosphate
Synthesis and activation of Vitamin D

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5
Q

Active form of Vitamin D

A

1,25-dihydroxycholecalciferol

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6
Q

What converts Vitamin to active form in kidney?

A

PTH

Phosphate

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7
Q

When is calcitonin secreted?

A

Severe hypercalcaemia to decrease serum Ca (inhibits Ocs, decreases absorption)

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8
Q

Symptoms of hypercalcaemia

A

Stones, bones, moans and groans

Tired, confused, depression, kidney stones, cardiac arrhythmias, muscle weakness, constipation, thirsty

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9
Q

Symptoms of hypocalcaemia

A

Cramp and tetany (increased excitability of skeletal muscle), pins and needles, breathing problems

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10
Q

Levels of PTH and Ca in primary hyperparathyroidism

A

High PTH, high Ca

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11
Q

Levels of PTH and Ca in secondary hyperparathyroidism

A

High PTH, low Ca

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12
Q

Levels of PTH and Ca in tertiary hyperparathyroidism

A

High PTH, High Ca

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13
Q

Treatment of hyperparathyroidism

A

Surgery if renal impairment/stones/osteoporosis/

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14
Q

Causes of hypoparathyroidism

A

DiGeorge syndrome, thyroid surgery, tumour, autoimmune, hypomagnaesaemia

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15
Q

Serum Ca and phosphate levels in hypoparathyroidism

A

Hypocalcaemia, hyperphosphataemia

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16
Q

Signs of hypocalcaemia

A

Chvostek sign: twitching of facial muscles when tapping facial nerve
Trousseau’s sign: inflation of BP cuff causes muscle tetany in hand/wrist (carpopedal spasm)

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17
Q

Treatment of hypoparathyroidism

A

Ca and Vit D supplements

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18
Q

Pseudohypoparathyroidism

A

Genetic

Resistance of PTH = high PTH, low Ca, high phosphate

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19
Q

Complications of pseudohypoparathyroidism

A

Subcutaneous calcification, mental retardation, brachydactyly (blunt 4th metacarpal), obesity, bone abnormalities

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20
Q

Levels of Ca, phosphate and PTH in Vitamin D deficiency

A

Low Ca and phosphate, high PTH = weak bone
Osteomalacia (gait deformities due to muscle weakness)
Rickets (bone deformity)

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21
Q

What are T scores in DEXA?

A

Compares BMD to mean result of young adult females

22
Q

What are Z scores in DEXA?

A

Compares BMD to females of same age

23
Q

Normal T score

A

Within 1 SD

24
Q

Osteopenia T score

A

Between 1-2.5 SD below

25
Q

Osteoporosis T score

A

Over 2.5 SD below

26
Q

Investigations in osteoporosis

A

Bone biochemistry (Ca, PTH, ALP)
Coeliac antibodies (malabsorption of Ca and Vit D)
Protein electrophoresis/Bence Jones proteins (myeloma)
Testosterone in males (hypogonadism)

27
Q

Management of osteoporosis

A

Exercise, diet, smoking cessation, limit alcohol, prevent falls (walking aids)
Ca and Vit D supplements
Bisphosphonates (anti-resorptive, alendronate, zoledronate)
HRT (early menopause)
Recombinant PTH (Teriparitide)
Denusomab (RANKL)
Strontium

28
Q

How do you test for MM?

A

Bence Jones proteins

Congo red stain - apple green birefringence

29
Q

Causes of hypocalcaemia

A

Hypoparathyroidism, Vit D deficiency, CKD, pancreatitis

30
Q

Treatment of acute hypocalcaemia

A

IV Calcium Gluconate 10% (10ml over 10 mins in glucose/saline)

31
Q

Ca release from cells is dependent on:

A

Mg

32
Q

In Mg deficiency, IC Ca is:

A

High = PTH inhibited = cells less sensitive to PTH

33
Q

Causes of hypomagnaesaemia

A

Alcohol, thiazides, PPIs, GI illness, pancreatitis, malabsorption

34
Q

Pseudopseudohypoparathyroidism

A

Normal Ca, high PTH

35
Q

CKD can cause:

A

Secondary hyperparathyroidism (high PTH, low Ca)

36
Q

Pros of using FRAX calculator

A

Uses BMD

Calculates 10 year risk

37
Q

Cons of using FRAX calculator

A

Underestimates vertebral # risk

Same risk applied to all secondary causes

38
Q

Pros of using Q#

A

More variables

Smoking and alcohol in quantities

39
Q

Cons of using Q#

A

Does not include BMD

40
Q

Who is assessed for osteoporosis?

A

Anyone over 50 with risk factors

Anyone under 50 with strong clinical risk factors (steroids/early menopause)

41
Q

Who is referred for DEXA?

A

10 year risk of fracture over 10%

42
Q

When is only the Z score reported?

A

If under 20 years

43
Q

When do you treat osteoporosis?

A

T score greater than 2.5 SDs

Steroids over 7.5mg and T score 1.5 SDs

44
Q

Effect of corticosteroids on bone

A

Decrease Ob activity
Decrease Ca absorption
Inhibit gonadal and adrenal steroid production

45
Q

Symptoms of Paget’s

A

Bone pain, deformity, deafness, compression neuorpathies, osteosarcoma, raised ALP

46
Q

Osteogenesis imperfecta signs:

A

Dentogenesis imperfecta, blue sclera, childhood fractures

47
Q

Causes of hypercalcaemia

A

Primary/tertiary hyperparathyroidism, malignant, Vit D, thiazides, sarcoid, TB, FHH, Paget’s

48
Q

Primary hyperparathyroidism

A

Overactivity of PT glands

High Ca, High PTH, increased urinary Ca

49
Q

Treatment of acute hypercalcaemia

A

0.9% saline 2-4 hours
Loop diuretics (AVOID thiazide)
Bisphosphonate

50
Q

Secondary hyperparathyroidism

A

Response to low Ca

Low Ca, High PTH

51
Q

Tertiary hyperparathyroidism

A

PT becomes autonomous after secondary

High Ca, High PTH

52
Q

FHH

A

High Ca, normal PTH, low urinary Ca
Autosomal dominant
Asymptomatic

Endocrine (13 decks)

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