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Year 2 Endocrine > Parathyroids > Flashcards

Parathyroids Flashcards

1
Q

What is the main function of parathyroid hormone ?

A

To increase Calcium concentrations

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2
Q

What does PLC do?

A

Inhibits PTH release

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3
Q

How is PLC controlled?

A

CASR calcium sensing receptor

Activation increases PCL secretion

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4
Q

What is CASR

A

A G protein coupled receptor

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5
Q

What are the four symptoms of Hypercalcaemia

A

Bones
Stones
Abdomina groans
Psychic moans

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6
Q

Acute signs of Hypercalcemia

A

Thirst
Dehydration
Confusion
Polyuria

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7
Q

Chronic signs of Hypercalcemia

A 
Myopathy
Fractures
Osteopenia
Depression
Hypertension
Pancreatitis
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8
Q

What drugs can cause Hyperparathyroidism?

A

Vitamin D supplements

Thiazides

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9
Q

List some causes of Hyperparathyroidism

A

Malignacy
Granulomatous diseases
High bone turn over
Familial

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10
Q

How does malignancy cause Hyperparathyroidism?

A

Metastatic bone destruction
PTHrp from solid tumours
Osteoclast activating factors

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11
Q

How can a malignant hyperparathyroidism be diagnosed?

A

Increased Ca2+ and alkaline phosphatase

X ray CT or isotope bone scan

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12
Q

What can lead to a high bone turn over?

A

Bed ridden
Pagets
Thyrotoxicosis

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13
Q

What are the signs of a primary hyperparathyroidism?

A

Raised serum Ca2+
Raised Serum PTH
Increased urinary Ca2+ excretion

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14
Q

What is the acute treatment for Hyperparathyroidism?

A 
0.9% saline 4-6L in 24 hrs
Loop diuretics
Bisphosphonates
Steroids 
Sodium Calcitonin
Chemotherapy
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15
Q

What diuretic should be avoided in the acute treatment of hyperparathyroidism?

A

Thiazide

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16
Q

When are steroids used and what is the first line?

A

Used in granulomatous diseases like sarcoid

Prednisolone 40 mg

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17
Q

Sodium calcitonin usage

A

Rarely used

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18
Q

In what circumstances is a parathyroidectomy undertaken?

A

End organ damage

Serum Calcium over 2.85

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19
Q

What is end organ damage in relation to Hyperparathyroidism?

A 
Bone disease 
Brown Tumour
Pepper pot skull
Gastric ulcers
Renal stones
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20
Q

Along with a high calcium what else must there be to undergo a parathyroidectomy?

A

Serum Calcium over 2.85
Under 50
eGFR <60ml/min

21
Q

What indicates a secondary Hyperparathyroidism

A

Low serum Ca2+

High PTH

22
Q

What is a secondary Hyperparathyroidism?

A

Physiological response to low Ca2+ or Vitamin D

23
Q

What indicates a tertiary Hyperparathyroidism?

A

High Ca2+ and PTH

24
Q

What is tertiary hyperparathyroidism?

A

Parathyroid has become autonomous due to chronic overactivity

25
Q

What genetic links does hyperparathyroidism have?

A

Links to MEN1/2

26
Q

Why will most people with MEN1/2 have Hyperparathyroidism?

A

Most will have a parathyroid adenoma

27
Q

As a result of the adenoma what will most MEN1/2 patients be affected by?

A

Hypercalcemia by a young age

28
Q

What is Hypocalciuric Hypercalcemia

A

Familial autosomal dominant

Usually benign asymptomatic

29
Q

What is the pathology behind Hypocalciuric Hypercalcemia?

A

Deactivation of the CaSR channels

No PLC release

30
Q

What are the symptoms of Hypocalciuric Hypercalcemia?

A

Mild Hypercalcemia
Reduced Ca2+ urinary excretion
PTH slightly elevated

31
Q

Signs of hypocalcaemia

A 
Parasthesia - fingers toes personally
Fatigue
Fits
Muscle weakness, cramps, 
Tetany
Bronchospasm
32
Q

On an ECG how may hypocalcaemia manifest?

A

Prolonged QT

33
Q

What is the acute treatment for hypocalcaemia?

A

IV Calcium Gluconate

34
Q

Causes of hypoparathyroidism

A

Congenital - Digeorge syndrome
Destruction- Surgery Radio/chemotherapy
Autoimmune
Hypomagnesaemia

35
Q

Management of hypoparathyroidism

A

> 1-2g of Calcium supplement

Vitamin D supplement

36
Q

What Vitamin D supplements are there?

A

Alphacalcidol

Cholecalciferol- Injection 6 monthly

37
Q

Why does hypomagnesaemia cause low Ca2+ levels?

A

Ca2+ release from the parathyroid is dependent of Mg+

38
Q

Biochemically how does hypomagnesaemia present?

A

Intracellular Ca2+ is high

Low PTH

39
Q

What can cause hypomagnesaemia?

A 
Thiazides
PPI
GI illness
Pancreatitis
Malabsorption
40
Q

What is diabetes insipidus?

A

Failure of the body to concentrate the urine

NO link to diabetes mellitus

41
Q

What are the two types of diabetes insipidus?

A

Nephrogenic - caused by fault within the kidneys

Neurogenic - caused by fault within the brain

42
Q

List some nephrogenic causes of diabetes insipidus

A

Lithium usage
Electrolyte imbalance
Kidneys unresponsive to ADH

43
Q

What electrolyte imbalance could lead to nephrogenic diabetes insipidus?

A

Low K+ High Ca+

44
Q

List some neurogenic causes of diabetes insipidus

A

Lesion
Tumour
Autoimmune
Head injury

45
Q

How do you work out the serum osmolarity?

A

[Na+ + K+]² + urea + glucose

46
Q

What is the normal serum osmolarity of the urine?

A

275-295 mmol/L

47
Q

What is the definition of diabetes insipidus?

A

High plasma osmolarity + urine osmolarity is low

48
Q

What is the definitive test for diabetes insipidus?

A

Water deprivation test

Year 2 Endocrine (21 decks)

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