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Endocrine > Path of the Parathyroid > Flashcards

Path of the Parathyroid Flashcards

1
Q

What are the three major pathologies of parathyroid disease?

A
  • Hyperparathyroidism
  • Parathyroid CA
  • Hypoparathyroidism
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2
Q

What is the most common cause of hyperparathyroidism?

A

Parathyroid adenoma

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3
Q

What defines PTH secreting adenomas (where, character)?

A

Lesions within the parathyroid gland that are not inhibited by elevated Ca levels

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4
Q

Excess PTH causes what? Why (4)?

A

Hypercalcemia:

  • Increase bone resorption
  • Increase renal reabsorption
  • Increase urinary excretion of phosphate
  • Increase renal Vit D synthesis
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5
Q

Why is there still calciuria in hyperparathyroidism, when PTH increases Ca reabsorption?

A

Filtered load of Ca is so high

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6
Q

What kidney pathology can be caused by hyperparathyroidism? Why?

A
  • Renal calculi

- Ca load so high, filtered out in high loads

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7
Q

What are the four major ssx of hyperparathyroidism?

A
  • Stones
  • Bones (osteomalacia)
  • Groans (Gastrin release causes PUD)
  • Moans (Mental changes)
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8
Q

What is the “groans” part of the ssx of hyperparathyroidism?

A

PTH induces gastrin release, causing PUDs

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9
Q

What are brown tumors?

A

Osteitis fibrosa cystica–replacement of bone with fibrous tissue 2/2 loss of Ca from hyperparathyroidism

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10
Q

What is the most common presentation of hyperparathyroidism?

A

Abdominal pain 2/2 PUD formation

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11
Q

In whom are parathyroid adenomas common?

A

Older women

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12
Q

What is the weight of parathyroid adenomas?

A

1 g

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13
Q

True or false: parathyroid adenomas are usually solitary, single lesions

A

True

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14
Q

What is the usual size of parathyroid glands (summed together)?

A

20-40 mg

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15
Q

What percent of parathyroid adenomas are in an ectopic location?

A

10%

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16
Q

What is the imaging modality that allows for easy visualization of parathyroid adenomas?

A

Sestamibi nuclear imaging

minimally invasive radioguided parathyroidectomy (MIRP

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17
Q

What is MIRP?

A

Minimally invasive radioguided parathyroidectomy–radioactive sestamibi that is preferentially absorbed by parathyroid adenomas

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18
Q

Where are most ectopic parathyroid adenomas found?

A

Mediastinum

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19
Q

What are the gross findings of a parathyroid adenoma?

A

Solitary, well circumscribed, tan-reddish brown nodules invested by a delicate capsule

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20
Q

Are parathyroid adenomas usually encapsulated?

A

Yes

21
Q

What defines a parathyroid carcinoma?

A

Adenoma that pierces the capsule

22
Q

What are the histological characteristics of a parathyroid adenoma? (3)

A
  • No fat cells
  • Primarily chief cells
  • Thin rim of normal parathyroid tissue
23
Q

What are the histological characteristics of the cells in parathyroid adenomas?

A

Chief cells with small, centrally placed nuclei with slight variation in nuclear size

24
Q

What is the second most common etiology of primary hyperparathyroidism?

A

Parathyroid hyperplasia

25
Q

What are the gross characteristics of parathyroid hyperplasia?

A

All 4 glands are big (unlike adenomas)

26
Q

How can you differentiate parathyroid hyperplasia vs an adenoma?

A

Adenoma is a single solitary lesions, whereas hyperplasia

27
Q

True or false: Parathyroid hyperplasia maintains the fat cells that the glands usually have

A

False–usually lack them

28
Q

What is the most common cause of parathyroid hyperplasia?

A

MEN syndromes

29
Q

How can you differentiate parathyroid hyperplasia vs adenoma?

A

Adenomas have a rim of parathyroid tissue

Hyperplasia has NO rim of normal parthyroidtissue

30
Q

What is secondary hyperparathyroidism?

A

Due to hypocalcemia from some other cause

31
Q

What is the most common cause of secondary hyperparathyroidism?

A

Chronic renal failure causing low Ca

32
Q

What is the most common type of tumor that produces calcitonin?

A

Medullary carcinoma of the thyroid

33
Q

What, besides CRF, can cause secondary hyperparathyroidism?

A

Malabsorption or nutritional deficit

34
Q

What is renal osteodystrophy? How do you treat this (2)?

A

Renal losses of Ca causes hyperparathyroidism

-Exogenous Calcitriol or partial parathyroidectomy

35
Q

Is the malignant potential of parathyroid carcinoma high or low? What about recurrence rate?

A

Low malignant potential, but high recurrence rates

36
Q

What is the treatment for parathyroid carcinoma?

A

50% cured by en bloc resection

37
Q

Where do parathyroid CAs metastasize to? Is this fast or slow

A

Lymphatic and hematogenous, but this is slow

38
Q

What are the histological characteristics of parathyroid CA?

A

Thick, fibrous bands

39
Q

Thick fibrous bands on a parathyroid sample = ?

A

Parathyroid carcinoma

40
Q

What is the gross appearance of a parathyroid carcinoma?

A

Gray-white irregular mass that may exceed 10 g in weight

41
Q

Do the cells in parathyroid carcinoma resemble normal parathyroid cells? How are they arranged?

A

Resemble normal cells, but are arranged in thick, fibrous bands

42
Q

True or false: histological examination of parathyroid glands is the a reliable diagnostic tool for parathyroid carcinoma

A

False–the only reliable criteria is if there is invasion of surrounding tissue and mets

43
Q

What is the most common cause of hypoparathyroidism?

A

Autoimmune disorder

44
Q

What is the most common acquired cause of hypoparathyroidism?

A

DiGeorge syndrome

chr 22 del and failure of the 3rd and 4th pharyngeal pouch

45
Q

What are the ssx of hypoparathyroidism?

A
  • metal changes

- circumoral paresthesia

46
Q

What are the end stages of hypoparathyroidism?

A

Convulsions and tetany

47
Q

How do you diagnose hypoparathyroidism?

A

Decreased serum [Ca] and increases serum [phosphate]

48
Q

What is the treatment for hypoparathyroidism?

A
  • Vit D
  • Ca gluconate cookies
  • Recombinant human PTH

Endocrine (32 decks)

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