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Endo II > Pathology of the Parathyroid > Flashcards

Pathology of the Parathyroid Flashcards

1
Q

normal weight of parathyroid

A

25-50mg each

there are 4 of them

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2
Q

color of parathyroid

A

yellowish

has fat

more fat with age

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3
Q

cells of parathyroid

A

chief cells

oxyphil cells - more red - more mito

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4
Q

function of PTH

A

increase renal tubular reabsorption of calcium

increase conversion of vit D

urinary phosphate excretion

GI calcium absorption

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5
Q

primary hyperparathyroidism

A

adenoma or hyperplasia of parathyroid tissue

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6
Q

secondary hyperparathyroidism

A

chronic renal failure

compensatory hypersecretion of PTH in response to prolonged hypocalcemia

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7
Q

tertiary hyperparathyroidism

A

renal transplant

persistant hypersecretion of PTH even after cause of prolonged hypocalcemia is corrected

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8
Q

most common cause of primary hyperparathyroidism

A

adenoma - 85%

primary hyperplasia - diffuse or nodular 5-10%

parathyroid carcinoma 1%

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9
Q

52yo F elevated Ca on medical profile

sestamibi scan shows hot nodule

A

parathyroid adenoma

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10
Q

calcitonin scan

A

sestamibi

-technetium scan

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11
Q

primary hyperplasia vs. adenoma

A

adenoma - glands outside adenoma are shrunken - feedback inhibiion

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12
Q

most common identification of primary hyperparathyroidism

A

incidental on serum electrolyte panel - see hypercalcemia

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13
Q

genetic parathyroid adenomas

A

MEN 1 - MEN1 mutation

MEN 2 - RET mutation

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14
Q

primary hyperparathyroidism physiologic changes

A

skeletal system - osteoporosis, brown tumors, osteitis fibrosa cystica

urinary tract - nephrolithiasis

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15
Q

skeletal changes hyperparathyroidism

A

osteoporosis - phalanges, vertebra, femur - cortical bone affected most

medullary bone - osteoclast tunnel - railroad track appearance - dissecting osteitis

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16
Q

railroad track appearance

A

of bones

hyperparathyroidism

dissecting osteitis

17
Q

brown tumor

A

bone loss in hyperparathyroidism - microfractures - influx of macrophages and fibrous tissue

hemosiderin deposition

18
Q

von recklinghausen disease of bone

A

osteitis fibrosa cystica

combo of increased osteoclast activity, peritrabecular fibrosis, cystic brown tumors

severe hyperparathyroidism**

19
Q

urinary tract and hyperparathyroidism

A

urinary tract stone formation - nephrolithiasis

also calcification of renal interstitium and tubules

20
Q

most common cause of asymptomatic hypercalcemia

A

primary hyperparathyroidism

21
Q

most frequent cause of symptomatic hypercalcemia in adults

A

malignancy

multiple myeloma

secretion of PTH-rP
-PTH related peptide

22
Q

high calcium and low PTH

A

high calcium of malignancy

multiple myeloma and others

23
Q

primary hyperparathyroidism associations

A

painful bones
renal stones
abdominal groans
psychic moans

24
Q

enlargement of all 4 parathyroid glands

A

secondary hyperparathyroidism
-hyperplasia

most commonly - with renal failure

25
Q

patients with secondary hyperparathyroidism

A

dietary vit D supps

phosphate binders

26
Q

tx tertiary hyperparathyroidism

A

minority of patients - becomes excessive hyperparathyroid

parathyroidectomy to control hyperparathyroidism

27
Q

common cause of hypoparathyroidism

A

consequence of surgery

during thyroidectomy

28
Q

autoimmune hypoparathyroid

A

mutations in AIRE

childhood onset of candidiasis
several years later hypoparathyroidism
adolescence adrenal insufficiency

29
Q

auto-dom hypoparathyroidism

A

GOF in SACR gene

hypocalcemia and hypercalciuria

30
Q

familial isolated hypoparathyroidism

A

FIH - rare

auto dom - mutation in PTH precursor peptide

auto rec - LOF function in GCM2 - essential for parathyroid development

31
Q

congenital absence of parathyroid

A

with other malformations

thymic aplasia
cardiovascular defects

22q11 deletion syndrome

32
Q

chvostek sign

A

tapping facial nerve - induce contraction of muscles of eye, mouth, nose

hypocalcemia**

33
Q

trousseau sign

A

carpal spasms - with occlusion of forearm circulation

hypocalcemia

34
Q

hypocalcemia

A

tetany - neuromuscular irritability

deceased serum calcium levels

35
Q

clinical of hypoparathyroidism

A

mental status changes

intracranial manifestations - parkinsonian like movement disorders

ocular disease - lens and cataracts - calcification

cardiovascular manifestations - prolonged QT interval

dental abnormalities

36
Q

pseudohypoparathyroidism

A

end organ resistance to PTH action

hypocalcemia, hyperphosphatemia, elevated circulating PTH

short stature, mental retardation, short 4th and 5th fingers

Endo II (12 decks)

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