PTH dz Flashcards
Hypercalcemia most commonly causeed by outpatient vs inpatient
Renal Gi MSK Neuro CV sx
hyperPTH malignancy
Polyuria, polydipsia, nephrolithiasis A/N/V/C bone pain, osteoporosis confusion, fatigue short QT, bradycardia
Stones
Bones
Moans
Groans
sx depend on
Mild hyperCa over time can be
rapid inc can present with
Kidney stones
bone pain
ab pain/constipation
psych sx
severity, how quickly level inc
asx/kidney stones
altered mental status/death
Tx of hyperCa depends on
asx pt/mild sx (Ca<12)
higher levels cause _____, so ____ is necessary
Pharm agents that may help
lab/sx
evaluate underlying cause
dehydration. fluids
Loop diuretics, bisphosphonates, calcitonin
MCC primary hyperPTH
less common
Sx
dx
next
cured via
parathyroid adenoma in one area that oversecretes PTH
2 areas involved (PTH hyperplasia)
can be asx, or hyperCa
Ca/PTH elevated
nuclear PTH scan to identify hyperfxn adenoma
surgical removal
Secondary PTH seen in pt w
kidneys do not convert enough
this stimulates
problem with kidney means that
CKD (advanced or on dialysis)
VD to active form, resulting in hypocalcemia
PTH to secrete PTTH
Ca is not elevated
2ndary PTH can result from
this is due to low
labs
prolonged dz leads to
malabsorption (IBD, chronic panc, bariatric surgery)
VD (low Ca, elevates PTH)
low/normal Ca
hyperCa (eventially 3ary PTH)
Tertiary PTH means PT glands
Malignancies leading to inc Ca
others (ie SCLC) secrete
dysregulated w chronic stimulation (from HypoCa) so PT gland secretes PTH regardless of Ca level
solid tumor, leukemia, MM, bone metastases
ectopic PTH (PTHrP), raising Ca levels
Milk Alkali Syndrome
High intake of milk or CaCarbonate leads to
typical pt
alkalosis will
High intake of Ca
Serum Ca elevation leads to
W CKD, decreased urination
HyperCa, Met Alk, renal insufficiency
takes excess CaCarbonate to treat osteoporosis/dyspepsia
stimulate Ca resoption in distal tubule of kidney, dec Ca excretion
rarely causes HyperCa
NF inhibiting PTH, w synthesis of calcitriol
results in problem, as phosphate binders are also being taken (binding Ca)
Pharm causes of hyperCa
additional drug
Familial Hypocalciuric Hypercalcemia
pattern
defect in
inhibits ___ on PT, so PTH will be
Presentation
thiazide diuretics- dec urinary Ca excretion
Li- inc PTH
AD
Ca sensor of PT gland
NF, high despite high serum Ca
asx
HypoCa sx
HypoPTH MCC
other cause
Digeorge syndrome causes
tetany, Chvosteks (facial muscles contract when tapped rapidly), Trousseas (carpal spasm following occlusion of brachial artery)
surgical excision during thyroidectomy
AI destruction (Rare)
congenital absence of PT glands, birth defects
Pseudohypoparathyroidism occurs when
pt becomes resistant to
PTH levels, Ca/Phos levels
MC condition assc
pattern
sx
PTH receptors dont work
PTH
inc, dec, Inc
Albright hereditary osteodystrophy
AD
developmental/skeletal defects
short stature, 4/5 digit
