Patho3 Flashcards
Renal changes PTH-induced hypercalcemia favors the formation of .. and
urinary tract stones = nephrolithiasis
calcification of the renal interstitium and tubules = nephrocalcinosis
secondary to hypercalcemia also may be seen in other sites, including the stomach, lungs, myocardium, and blood vessels
Metastatic calcification
Clinical Features of primary hyperthyroidism
Age
gender
Most common manifestation
disease of adults
F > M →gender ratio of nearly 4 : 1
increase in serum ionized calcium
most common cause of clinically silent
hypercalcemia.
Primary hyperparathyroidism
most common cause
of clinically apparent hypercalcemia in adults
cancer
Clinical Features of Primary hyperparathyroidism
secretion of PTH-like polypeptides and osteolytic bone metastases
individuals with hypercalcemia caused by parathyroid hyperfunction→
serum PTH is
inappropriately elevated,
hypercalcemia caused by nonparathyroid diseases→
serum PTH is
low to undetectable in those including malignancy
Other laboratory alterations referable to PTH excess include→
Hypophosphatemia increased urinary excretion of both calcium and phosphate
Primary hyperthyroidism traditionally has been associated with a constellation of symptom
painful bones, renal stones, abdominal groans, and psychic moans
Additional signs and symptoms that may be encountered in some cases include the
following:
Gastrointestinal disturbances→
constipation, nausea, peptic ulcers, pancreatitis, and gallstones
Additional signs and symptoms that may be encountered in some cases include the
following: • Central nervous system alterations→
depression, lethargy, and seizures Neuromuscular abnormalities, including weakness and hypotonia
Additional signs and symptoms that may be encountered in some cases include the
following:
Polyuria and secondary polydipsia
Secondary hyperparathyroidism is caused by chronic depression of serum
calcium levels, most often as a result of
renal failure→ compensatory
overactivity of the parathyroids.
Chronic renal insufficiency is associated with decreased
phosphate excretion which results in hyperphosphatemia
in addition, loss of … activity, which is required for the
synthesis of the active form of vitamin D, reduces the intestinal absorption of calcium
renal α1-hydroxylase
Alterations of secondary HYPERPARATHYROIDISM causes .. which stimulates
chronic hypocalcemia
activity of the parathyroid glands
MORPHOLOGY of secondary hyperthyroidism
The parathyroid glands are hyperplastic
The degree of glandular enlargement is not necessarily symmetric
LM of secondary hyperthyroidism
hyperplastic glands contain →
an increased number of chief cells, or cells with more abundant, clear cytoplasm = water-clear cells,
in a diffuse or multinodular distribution fat cells are decreased in number
… calcification may be seen in many tissues in secondary hyperthyroidism
Metastatic
The clinical manifestations of secondary hyperparathyroidism usually are
dominated by
those related to chronic renal failure
Bone abnormalities = renal osteodystrophy and
other changes associated with PTH excess →… severe than those seen in
primary hyperparathyroidism
less
Serum calcium secondary hyperparathyroidism
remains near normal
The metastatic calcification of blood vessels (secondary to …) occasionally may result in ….
hyperphosphatemia
ischemic damage to skin and other organs=
calciphylaxis
In a minority of patients, parathyroid activity may become autonomous and
excessive
tertiary hyperparathyroidism
may be necessary to control the hyperparathyroidism in such
patients.
Parathyroidectomy
