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MM Test 3 > B6.050 Prework 1: Hyperparathyroidism > Flashcards

B6.050 Prework 1: Hyperparathyroidism Flashcards

(56 cards)

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1
Q

how many parathyroid glands are there

A

85% of people have 4

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2
Q

origin of superior parathyroid glands

A

arise from 4th brachial pouch

more constant in location than inferior glands

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3
Q

location and blood supply of superior parathyroid glands

A

usually within 1 cm of where the recurrent laryngeal nerve pierces the cricothyroid membrane
perfused by inferior thyroid artery

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4
Q

origin of inferior parathyroid glands

A

arise from 3rd brachial pouch

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5
Q

location and blood supply of inferior parathyroid glands

A 
typically within 1 cm of where inferior parathyroid artery enters the thyroid
more often ectopic than superior glands
-tracheoesophageal groove
-paratracheal fat
-thymus
perfused by the inferior thyroid artery
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6
Q

common locations of ectopic parathyroid glands

A 
15% within the thymus
1% intra thyroidal
3-5% within the posterior mediastinum or carotid sheath
aortopulmonary window
paraesophageal
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7
Q

primary cell of parathyroid

A

chief cells

properties vital to homeostatic function

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8
Q

function of chief cells

A

rapidly secrete stored PTH hormone in response to changes in blood calcium (seconds)
synthesize, process, and store large amounts of PTH in a regulated manner (hours)
replicate when chronically stimulated (days)

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9
Q

description of PTH production

A

synthesized as a larger precursor
pre-pro-PTH (115 AA)
transit across ER, pre sequence cleaved
in Golgi, pro sequence cleaved

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10
Q

biologically active form of PTH

A

intact PTH, 84 AA

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11
Q

function of PTH

A

peptide hormone that control the minute to minute level of serum ionized Ca2+

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12
Q

where are surface receptors for PTH located

A

bone and kidney

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13
Q

major physiological responses to PTH

A

bone resorption
renal reabsorption
increased renal synthesis of 1,25(OH)2D3
increased intestinal absorption of dietary calcium

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14
Q

how does PTH influence phosphate reabsorption in kidney

A

decreased reabsorption of phosphate

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15
Q

how does PTH influence phosphate absorption in intestines

A

increased absorption of phosphate

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16
Q

what receptor on the chief cell senses calcium levels in serum

A

CaSRs on cell surface

member of G protein coupled family of receptors

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17
Q

response to hypocalcemia

A

increased PTH secretion

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18
Q

response to hyperphosphatemia

A

VERY increase PTH secretion

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19
Q

action of calcitriol on PTH levels

A

inhibits PTH synthesis by interacting with vitamin D receptor

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20
Q

metabolism of PTH

A

half life = 4 min

metabolized by liver (70%) and kidney (20%)

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21
Q

impact of familial hypocalciuric hypercalemia on function of parathyroid

A

inactivating mutation
parathyroid glands less sensitive to calcium
at kidney increased reabsorption of Ca2+ and Mg
increased PTH, Ca2+, and Mg
decreased urine calcium

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22
Q

impact of familial hypoparathyroidism with hypercalciuria

A

activating mutation of the CaSR
decreased serum calcium and PTH
increased urine calcium

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23
Q

dietary forms of vit D

Study These Flashcards
A

D3: cholecalciferol (animal products)
D2: ergocalciferol (plants)
+
7-dehydrocholesterol from UV light

24
Q

liver metabolism of vit D

Study These Flashcards
A

activated to calcidiol (25OH vit D)
circulating form
this form is measured for vit D status
2-3 week half life

25
kidney metabolism of vit D
activated to calcitriol (1,25(OH)2 vit D) 6-8 hour half life exerts effects on body (increased intestinal Ca absorption, increased bone resorption, decreased renal Ca and phosphate excretion)
26
direct effects of 1,25(OH)2D3
active form binds to vitamin D receptor promotes enterocyte differentiation / intestinal absorption of Ca and PO4 direct suppression of PTH release regulation of osteoblast function permissively allows PTH induced osteoclast activation and bone resorption
27
mnemonic for signs and symptoms of primary HPTH
stones bones groans psychiatric overtones
28
renal symptoms of HPTH
``` renal stones nephrocalcinosis polyuria polydipsia uremia ```
29
MSK symptoms of HPTH
osteitis fibrosa radiologic osteoporosis osteomalacia or rickets arthritis
30
abdominal symptoms of HPTH
constipation indigestion, nausea, vomiting peptic ulcer pancreatitis
31
psych symptoms of HPTH
``` lethargy, fatigue depression memory loss psychosis-paranoia personality change confusion, stupor, coma ```
32
Ca2+ correction equation
corrects serum calcium for albumin | (4-Alb)*0.8 + Ca
33
etiologies of hypercalcemia w/ elevated or mid to high normal PTH
pHPTH FHH differentiate by urine excretion (FHH is low, pHPTH is high)
34
etiologies of hypercalcemia w/ low PTH
non-PTH mediated | measure PTH related peptide (PTHrp) and vit D metabolites
35
PTHrp elevated
scan for malignancy
36
elevated 1,25D
chest x-ray for lymphoma, sarcoid
37
elevated 5D
check meds, vitamins, supplements
38
management of mild hypercalcemia
<12 mg/dL | no immediate treatment
39
management of severe hypercalcemia
>14 mg/dL volume expansion with isotonic saline administer calcitonin administer IV bisphosphonate
40
primary cause of pHPTH
parathyroid adenoma (89-95%) single gland mostly composed of chief cells oxyphil cells to a lesser extent
41
other causes of pHPTH
``` parathyroid hyperplasia (6%) -four glands affected equally -chief cell hyperplasia parathyroid carcinoma (rare) -very increased PTH (hundreds) -Ca2+ > 14 ```
42
epidemiology of pHPTH
women most commonly affected 1% of gen pop 2% elderly pop
43
diagnosis of pHPTH
increased serum chloride to phosphorus ratio >33:1
44
surgical indications for pHPTH
``` symptomatic disease (bones, stones, groans, psych overtones) asymptomatic disease - Ca over 1 mg/dL above upper limit -creatinine clearance <60 -osteoporosis -<50 years old ```
45
FHH description
``` benign, no ttx indicated autosomal dominant mild hypercalcemia with hypocalciuria normal to slightly elevated PTH high-normal to frankly elevated serum Mg level ```
46
secondary HPTH
seen in patients with renal failure an appropriate increase in PTH responds to chronically low calcium most DO NOT need surgery
47
treatment of secondary HPTH
dietary restrictions phosphorus binding gels calcium dialysate options
48
eventual fate of parathyroid glands in secondary HPTH
eventually become autonomous | -even with correction of serum calcium via renal transplant, PTH remains inappropriately elevated (TERTIARY HPTH)
49
surgery for secondary/tertiary HPTH
subtotal (3.5) / total parathyroidectomy with reimplantation
50
what is hypercalcemia of malignancy?
present in 20% of cancer patients (esp lung) malignant cells elaborate humoral mediators of hypercalcemia (PTHrp) rarely result from direct bony destruction by tumor ingrowth
51
endogenous PTH in hypercalcemia of malignancy
scarce or undetectable | requires suspicion of malignancy on part of physician
52
cortical bone
outer part dense and compact maintains structural function of bone
53
metabolic function of skeleton
storage for calcium, phosphorus, and carbonate
54
trabecular bone
inside long bones and vertebrae | maintains metabolic function of bone
55
T score
number of standard deviations from young adult mean density
56
Z score
number of standard deviations from age matched mean density | applies to pre-menopausal females and males <50

MM Test 3 (31 decks)

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