Pathology Part II

Question 1

These cells regulate free ionized calcium via PTH

Answer 1

Chief cells (of the parathyroid)

Question 2

How to do chief cells regulate ionized calcium?

Answer 2

1. increase bone osteoclast activity - releasing Ca and Phosphate
2. Increase small bowel absorption of calcium and phosphate (indirect vit D activation)
3. Increase renal calcium reabsorption (distal tubule) and decrease phosphate reabsorption (proximal tubule)

Question 3

Increased serum calcium provides this type of feedback to the parathyroid

Answer 3

Negative.

Increased serum Ca leads to a decrease in PTH secretion.

Question 4

Define primary hyperparathyroidism

Answer 4

Excess PTH due to a disorder of the parathyroid gland itself

Question 5

Most common cause of hyperparathyroidism?

Answer 5

Parathyroid adenoma (80%)
Sporadic parathyroid hyperplasia
parathyroid carcinoma

Question 6

How do parathyroid adenomas most often present?

Answer 6

benign hypercalcemia

Question 7

Laboratory findings of hyperparathyroidism?

Answer 7

increased PTH
increased Ca
decreased Phos.
Increased urinary cAMP
increase serum alk phos

Question 8

Most common cause of secondary hyperparathyroidism?

Answer 8

Chronic renal failure

Question 9

Pathophysiology of CRF and secondary hyperparathyroidism?

Answer 9

Renal insufficiency - decreased phosphate excretion
Increased serum phosphate - binds free Ca
Decreased free Ca stimulates parathyroid glands
Increased parathyroid gland activity stimulates bone resorption

Question 10

Lab findings of secondary hyperparathyroidism?

Answer 10

Increased PTH
decreased Ca
increased serum phos
increased alk phos

Question 11

What differences in lab findings will you see between primary and secondary hyperparathyroidism?

Answer 11

Primary: Increased Ca, decreased phosphate

secondary: decreased Ca, increased phosphate

Question 12

List some causes of hypoparathyroidism

Answer 12

Autoimmune damage
surgical excision
Di George syndrome

Question 13

How do symptoms of low serum calcium often present?

Answer 13

Numbness and tingling

Muscle spasm

Question 14

Lab results of hypoparathyroidism

Answer 14

Low PTH

Low serum calcium

Question 15

End organ resistance to PTH (high PTH levels)

Answer 15

Pseudohypoparathyroidism

Question 16

The endocrine pancreas is composed of these types of cells

Answer 16

Islet cell cluster
B cells - insulin
A cells - glucagon

Question 17

Insulin MOA

Answer 17

upregulates insulin dependent glucose transporter protein (GLUT4) on skeletal muscle and adipose tissue

Question 18

Type I diabetes HLA

Answer 18

DR3 and DR4

Question 19

Etiology of CV disease among diabetics

Answer 19

Nonenzymatic glycosylation (NEG) of vascular membranes

Question 20

What number measures the NEG of Hgb (glycated Hgb)

Answer 20

HbA1C

Question 21

Pancreatic endocrine neoplasms often are a component of this endocrine syndrome

Answer 21

MEN 1

along with Parathyroid hyperplasia and pituitary adenoma

Question 22

Lab values in pt with insulinoma

Answer 22

Decreased serum glucose
Increased insulin
increased C peptide

Question 23

Three layers of adrenal cortex and the hormones they produce

Answer 23

Glomerulosa - mineralocorticoids
Fasciculata - glucocorticoids
Reticularis - androgens

Question 24

What are all steroid hormones derived from

Answer 24

Cholesterol

Question 25

Primary hyperaldosteronism is most commonly due to this condition

Answer 25

Bilateral adrenal hyperplasia

Question 26

Tx for primary hyperaldosteronism

Answer 26

mineralocorticoid receptor antagonist such as spironolactone or eplerenone
if adenoma – surgically resect

Question 27

Classical presentation for hyperaldosteronism?

Answer 27

HTN
Hypokalemia
metabolic alkalosis

Question 28

How will Liddle syndrome vary from hyperaldosteronism when running tests

Answer 28

Will have LOW aldosterone