12. Hypoparathyroidism and Pseudohypoparathyroidism Flashcards Preview

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Flashcards in 12. Hypoparathyroidism and Pseudohypoparathyroidism Deck (11)
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1
Q

how many parathyroid glands do we have ?

A

four parathyroid glands

2
Q

what is the function of the parathyroid gland ?

A

releases in response to low calcium levels = which causes the bones to give out calcium
increase calcium absorption for GI tract
increase calcium absorption from kidney with phosphate please

activation of VITAMIND d in kidneys
1,25 - dehydroxyvitD3 = calcitriol = only produced in the presence of PTH
having a much stronger effect than PTH = causes resorption of calcium

cholecalciferol produced UV from the skin goes to the liver and then the kidneys to be transformed into calciitriol

antagonist is calcitonin from the thyroid gland = when there is a lot of calcium in the blood

3
Q

how does the blood ph regulate the calcium levels ?

A

during alkalosis the plasma protein which bind to hydrogen ions are released
causing the free calcium to bind = HYPOCALCEMIA

it is the free calcium which is active

when there is acidosis - there is hypercalcemia

4
Q

what is the cause of hypoparathyroidism ?

A

Thyroidectomy that also resulted in parathyroidectomy

after radiation therapy in the
neck region

autoimmune

Congenital:
Parathyroid aplasia or hypoplasia (DiGeorge syndrome)

non autoimmune destruction - hemochrombtosis

5
Q

what are the clinical signs and symptoms of hypoparathyroidism ?

A
Acute manifestations
 hypocalcemia  : tetany 
muscle cramp 
parathesia and tingling 
laryngospasm 

Chvostek sign: hypocalcemia tapping the facial nerve on the cheek → contraction of facial muscles

Trousseau sign: occlusion of brachial artery for a few minutes → carpal spasm

Chronic manifestations
Extrapyramidal disorders : parkinsonism, dystonia,

seizures

Ocular disease: cataracts, keratoconjunctivitis

Skeletal: increased bone mineral density, osteosclerosis

Dental abnormalities: dental hypoplasia, failure of tooth eruption, defective root formation

dry, puffy, coarse skin
and oncholysis

cv = cardiac arrhythmia

6
Q

what is the diagnosis of hypoparathyroidism ?

A

positive Chvostek sign: hitting N. facialis in front of the external ear canal causes
muscle contractions in fac

Trousseau sign: muscular contraction of the hand when inflating a blood pressure cuff on the arm above systolic blood pressure for 3 minutes

Central nervous system basal ganglia calcifications through ct or MRI scan

definite

combination of hypocalcemia + hyperphosphatemia + LOW
PTH

7
Q

what is dd of hypoparathyroidism ?

A

hyperventilation = respiratory alkalosis
the total Ca2+ in blood is serum is
NORMAL, only the the free calcium is decreased

Hypomagnesemia:
magnesium needs for pth to be produced 
we have low PTH!  low Ca2+,
high Phosphate aaaaaand l
ow Mg
8
Q

treatment of hypoparathyroidism ?

A

acute Hypocalcemia: I.V. calciumgluconate which will quickly increase calcium
levels and thus will relieve symptom

The goal of treatment is to maintain the blood calcium level near the low end of the normal range!

chronic hypothyroidism:
Calicum and activated Vitamin D - calciferol , calcitriol , alphacalcidol

recombinant PTH analogous

thiazides diuretics + low sodium diet = reduce calcium excretion

9
Q

what is pseuohypoparathyroidism ?

A

resistance to the parathyroid hormone

10
Q

what is the diagnosis of pseudohypoparathyroidism ?

A
have a low serum calcium and high phosphate, but the parathyroid
hormone level (PTH) is appropriately hig
11
Q

what are the signs and symptoms of pseudohypoparathyroidism ?

A

the end-organ resistance is accompanied by a specific patterncalle -Albright hereditary osteodystrophy:
short stature
brachydactyly of 4th and 5th metacarpal or metatarsal
obesity - round facies
ectopic soft tissue
dermal ossification

carpo-pedal muscular spasms,

IQ is typically mildly depressed

any every other hypocalcemia symptoms