31. Hyperparathyroidism Flashcards Preview

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Flashcards in 31. Hyperparathyroidism Deck (30):
1

hypeparathyroidism - is divide to

1. primary
2. secondary
3. tertiary

2

primary hyperparathyroidism - due to

1. parathyroid adenoma ( MCC)
2. parathyroid hyperplasia
3. parathyroid carcinoma ( rare)

3

primary hyperparathyroidism - labs

1. hypercalcemia
2. hypercalciuria
3. hypophosphatinemia
4. increased PTH
5. increased c AMP inurine
6. increased ALP

4

primary hyperparathyroidism - symptoms

1. MOST OFTEN ASYMPTOMATIC
2. weakness
3. constipation
4. abdominal/ flank pain ( kidney stones, acute pancreatitis, peptic ulcer), depression
5.bone pain

5

primary hyperparathyroidism - abdominal / flank pain due to

kidney stones, acute pancreatitis, peptic ulcer

6

primary hyperparathyroidism - mCC ( and proportion)

parathyroid adenoma (>/0%)

7

primary hyperparathyroidism - causes on bones

osteritis fibrosa cystica

8

osteritis fibrosa cystica ?

cystic bone spces filled with brown fibrous tissue

9

osteritis fibrosa cystica -brown fibrous tissue

brown tumor constisting of osteoclasts and deposited hemosiderin from haemorrhage

10

osteritis fibrosa cystica - when

primary hyperparathyroidism

11

secondary hyperparathyroidism

2ry hyperplasia due to a disease process extrincic to the parathyroid gland - decreased Ca2+ and / or increased PO43-

12

MCC of secondary hyperparathyroidism

chronic renal disease

13

chronic renal disease causes secondary hyperparathyroidism due to

1. hypovitaminosis D --> decreased Ca2+ absorption
2. dereased phosphate exertion --> serum Pi bind free Ca2+ --> decreased free calcium

14

secondary hyperparathyroidism - chronic renal failure vs most other causes

chronic renal disease : hyperphosphatemia
most other causes : hypophosphatemia

15

secondary hyperparathyroidism - labs

1. hypocalcemia
2. increased ALP
3. increased PTH
4. hyperphosphatemia ( if chronic renal disease)
5. hypophosphatemia ( most other causes )

16

secondary hyperparathyroidism - bone

renal osteodystrophy - bone lession due to 2ry or 3ry
hyperparathyroidism due in turn to renal disease

17

tertiary hyperparathyroidism

refractory ( autonomous) hyperparathyroidism resulting from chronic renal disease

18

tertiary hyperparathyroidism - labs

1. increased calcium
2. largely increased PTH

19

hypercalcemia with decreased PTH - called

PtH - independent hypercalcemia

20

PTH - independent hypercalcemia - labs

hypercalcemia with decreased PTH

21

causes of PTH - independent hypercalcemia

1. excess Ca2+ ingestion
2. cancer

22

pseudopseudohypoparathyroidism - mechanism / presentation

physcial exam features of ALbright hereditary osterodystrphy ( 1. short stature 2. shortended 4th / 5th digits ) but without end - organ PTH resistance --> occurs when the defective Gs protein α - subunit is inherited from father

23

A patient has hypercalcemia, hypercalciuria, hypophosphatemia, and high PTH. What are two likely causes? What other lab values do you see?

Parathyroid adenoma or parathyroid hyperplasia; high serum ALP and high urine cAMP

24

A man has intense dysuria and flank pain, constipation, weakness, and bone pain. What is the likely diagnosis? What causes the bone pain?

Primary hyperparathyroidism; osteitis fibrosa cystica (brown fibrous tissue fills cystic bone spaces)

25

• What is the mechanism by which a patient develops secondary hyperparathyroidism?

Decreased calcium absorption from the gut and increased levels of phosphate causing secondary hyperplasia of the parathyroid gland

26

What is the most common cause of secondary hyperparathyroidism?

Chronic renal disease, which causes hypovitaminosis D and thus low Ca2+ absorption from the gut

27

• A patient with chronic renal failure has secondary hyperparathyroidism. What labs do you see? How do labs differ in normal kidneys?

Hypocalcemia, hyperphosphatemia, high alkaline phosphatase, and high PTH; hypophosphatemia if not due to chronic renal failure

28

• You take an x-ray of a patient with dialysis. What pathologic condition of bone might you see?

Renal osteodystrophy (bone lesions caused by renal failure–induced secondary or tertiary hyperparathyroidism)

29

• A man on dialysis with recently diagnosed secondary hyperparathyroidism has new bone pain, abdominal pain, and high Ca2+. Pathophysiology?

Hyperplastic parathyroid cells can become autonomous, resulting in very high PTH (and thus high Ca2+) (tertiary hyperparathyroidism)

30

What are the classic signs and symptoms of hyperparathyroidism?

Stones (renal stones), bones (cystic bone spaces), groans (constipation), and psychiatric overtones (depression)