Path: Parathyroid Flashcards

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1
Q

Parathyroid glands are derived from what? along with what other gland

A

Derived from 3rd and 4th branchial pouches along with thymus

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2
Q

What condition manifests with lack of Parathyroid glands

A

DiGeorge syndrome

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3
Q

type of cells (2) in the parathyroid glands, their color, and which produces PTH?

A
chief = PTH = blue
oxyphil = pink
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4
Q

5 ways PTH raises calcium

A

i. Increasing Ca++ reabsorption by the renal tubules
ii. Converting vitamin D to active form in kidney
iii. Increasing Phosphate excretion in kidney
iv. Increasing GI absorption of Ca++
v. Activating osteoblasts –> RANKL –> osteoclasts –> resorb bone

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5
Q

What is the MC cause of clinically apparent hypercalcemia.

A

Malignancy

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6
Q

Mechanism of hypercalcemia in Sarcoidosis

A

(upregulated 1-α hydroxylase –> production of active vit D)

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7
Q

adenoma or CA of parathyroids usually leads to hyperPTH?

A

adenoma

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8
Q

Primary hyperPTH is seen in what 2 familial conditions

A

MEN1/2 and

familial hypocalciuric hypercalcemia

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9
Q

What is typical age/gender of Primary hyperPTH

A

> 50, females

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10
Q

What causes familial hypocalciuric hypercalcemia

A

defective CaSRs (calcium-sensing receptors) means it takes higher Ca levels to suppress PTH –> excesive renal Ca++ uptake–> hypercalcemia/hypocalciuria

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11
Q

What is the MC cause of asymptomatic/incidental hypercalcemia

A

Primary hyperPTHism

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12
Q

What bone condition is caused by Primary hyperPTHism?

A

Osteitis Fibrosis Cystica

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13
Q

What is going on in Osteitis Fibrosis Cystica? one hallmark/buzzword

A

Bone resorption–> hemorrhagic, cystic marrow–> “brown tumors” that consist of osteoclasts and hemosiderin (not malignant)–> bone pain

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14
Q

What 2 things happen to the kidneys in Primary hyperPTHism

A

Stones and Nephrocalcinosis = interstitial and tubule calcification

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15
Q

What is the mnemonic for CP of Primary hyperPTHism?

A

“bones, stones, groans, psychiatric overtones”

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16
Q

What is the “groans” component referring to (3)

A

pancreatitis- Ca activates enzymes
kidney stones
constipation

17
Q

What change is seen in histo in hyperplasia and adenomas of parathyroid gland

A

loss of stromal fat

18
Q

Gross difference between adenoma/CA and hyperplasia

A
hyperplasia = all 4 glands enlarged
adenoma/CA = only one gland enlarged
19
Q

How is Carcinoma diagnosed?

A

presence of local invasion/mets. (through capsule)

20
Q

WHat is MC cause of Secondary HyperPTH

A

Reanl failure is MC cause

21
Q

How does renal disease cause Secondary HyperPTH (2)

A

Phosphate retention –> low serum Ca++

ALso –> low vitaminD dt lack of 1@-hydroxylase activity

22
Q

What is and what is the cause of Tertiary HyperPTH?

A

Autonomous hyperPTH dt chronic renal dz (high PTH no matter what Ca levels are doing)

23
Q

hypoparathyroidism is caused by what gene defect

A

APS1/AIRE gene

24
Q

What are the two named signs of hypoparathyroidism

A

chvostek, trousseau

25
Q

low serum Ca++ causes what Cardiac signs

A

v. Cardiac: QT prolongation.

26
Q

low serum Ca++ causes what intracranial sx (3)

A

parkinsonian sx, increased ICP, papilledema

27
Q

low serum Ca++ causes what in CNS and eye

A

AMS- irritability, psychosis, anxiety

Cataracts (calcification of ocular lens)

28
Q

In Pseudohypoparathyroidism: CP

A

short stature, short 4th and 5th digits

29
Q

Pathogenesis of Pseudohypoparathyroidism

A

unresponsiveness of kidney to PTH

30
Q

Pseudohypoparathyroidism: PTH and Ca levels

A

low Ca (despite) normal/high PTH

31
Q

Pseudohypoparathyroidism is due to an inactivating mutation of what

A

Gs protein alpha subunit (GNAS1) –> loss of PTH signal in renal cells