The Parathyroid Gland Flashcards
Draw the overview of the Parathyroid and Calcium System
What is the pathway of Vitamin D activation?
1) By the skin to D3
2) By the liver to 25 hydroxyvitamin D
3) By the kidney to 1,25 dehydroxyvitamin D (Calcitrol). This is controlled by PTH and causes increased calcium uptake
What does calcitonin do?
It decreases calcium resorption
Low calcium means low calcitonin and low deposition and high absorption
High calcium means high calcitonin and high deposition and low absorption
What are the symptons, investigations and treatment of Primary Hyperparathyroidism.
What is the process?
Increased PTH causing increased calicum and calicum blocks transmission
Symptoms - Stones, moans, groans, thrones psychiatric overtones
Investigations. HIGH PTH, HIGH CALCIUM, HIGH URINE CALCIUM LOW PHOSPHATE
**Treatment **- Surgery, observation
What are the symptoms, investigations and treatment of secondary hyperparathyroidism?
What is the process?
Low calcium causes an increase in PTH
Symptoms - Stones, moans, groans, thrones psychiatric overtones or NONE
Investigations. HIGH PTH, Normal CALCIUM, HIGH PHOSPHATE
Treatment - Surgery, observation
What is the relatioship between calcium and phosphate?
Usually mirror, except in seconday hyperparathyroidism
What are the symptoms, investigations and management of tertiary hyperparathyroidism?
What is the process?
Long term low Calcium leads to hight PTH and high calcium. Different to secondary where calcium levels are normal
Symptoms - Stones, moans, groans, thrones psychiatric overtones
Investigations. HIGH PTH, HIGH CALCIUM, LOW PHOSPHATE
Treatment - Surgery, observation
What are the symptoms and investigations of malignant hypercalcemia?
What is the process?
Malignancy causing high calcium levels. This needs to be addressd by treating the malignancy
**Symptoms ** - Stones, moans, groans, thrones psychiatric overtones and WEIGHT LOSS
Investigations - Low PTH, HIGH Calcium, Low phosphate
What are the symptoms, investiagations, treatment and pathology of hypoparathyroidism?
Symptoms - Diarrhoea, pins and needles, tinnitus, clonus, Increased bone density.
Investigations - LOW PTH, LOW CALCIUM, HIGH PHOSPHATE, HIGH BONE DENSITY
Treatment - with calcium or vitamin D to increase absorption
Pathology - Underactive parathyroid meaning less calcium in the blood but more in the bones
Calcium limits nerve transmission so without it there are postiive nerve signs
This is often associated with surgery
Investigations - LOW PTH, LOW CALCIUM, HIGH PHOSPHATE, HIGH BONE DENSITY
What are the symptoms, investigations, treatment and pathology of pseudohypoparathyroidism?
Symptoms - Should metacarpals and round face - Albrights heriditary dystrophy
Investigations - High PTH, Low Calcium, High phosphate
Pathology - An end organ resistance to PTH so althought it is here there is low calcium, causing symptoms.
Treatment - Vitamin D to try and increase calcium levels
What are the symptoms, investigations, management and pathology of hypomagneasimia?
Symptoms - Tinnitus, diarrhoea, clonus, pins and needles
Investigations - Low calcium, low PTH and low magnesium
Pathology - Magnesium is needed for PTH
Treatment - Magnesium
What are the symptoms, investigations and treatment of hypervitamindosis and what is it associated with?
Symptoms - Stones, moans, groans, bones, psychiatric overtones
Investigations - High Vit D, high Calcium, Low PTH
Treament - Stop diet, steroids for sarcoidosis
Pathology - Associated with diet, or SARCOIDOSIS
Too much VIt D causes increased Calcium and associated symptoms
Where is calcitonin released from?
Parafollicular cells of Thyroid
What is a key sign of hypoparathyroidism and what is hypoparathyroidism often associated with?
Increased bone density
Surgery
What differentiates primary and tertiary hyperparathyroidism?
PTH is much higher in tertiary
