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2a- Endocrinology > Calcium and Parathyroid Hormone > Flashcards

Calcium and Parathyroid Hormone Flashcards

1
Q

What are the actions of PTH?

A

Ca2+ reabsorption
Bone resorption
Indirect Ca2+ absorption (increased 1,25 (OH)2 vit D

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2
Q

Is it hypocalcaemia if low serum albumin, low total serum calcium but not a low ionised calcium?

A

No

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3
Q

What is the equation for working out corrected calcium?

A

total serum calcium + 0.02 * (40 – serum albumin)

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4
Q

What are consequences of hypocalcaemia?

A
  • Parasthesia
  • Muscle spasm
    • Hands and feet
    • Larynx
    • Premature labour
  • Seizures
  • Basal ganglia calcification
  • Cataracts
  • ECG abnormalities
    • Long QT interval
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5
Q

What is Chvostek’s Sign?

A
  • Tap over the facial nerve
  • Look for spasm of facial muscles
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6
Q

What is Trousseau’s Sign?

A
  • Inflate the blood pressure cuff to 20 mm Hg above systolic for 5 minutes
  • Hand forms shape
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7
Q

What could cause hypocalcaemia?

A

Vit D deficiency

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8
Q

What will the levels of PTH be like in vit D deficiency (secondary hyperparathyroidism)?

A

High

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9
Q

What will the levels of calcium be like in vit D deficiency (secondary hyperparathyroidism)?

A

Low

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10
Q

What will the levels of phosphate be like in vit D deficiency (secondary hyperparathyroidism)?

A

Low

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11
Q

Is the action of PTH appropriate or inappropriate in vit D deficiency (secondary hyperparathyroidism)?

A

Appropriate
- In attempt to raise calcium
- Increased phosphate excretion in kidney

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12
Q

What can cause hypoparathyroidism?

A
  • Surgery
  • Radiation
  • Syndromes
  • Developmental abnormality of third and fourth branchial pouches
  • Genetic
  • Autoimmune
  • Infiltration
  • Magnesium deficiency
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13
Q

How can surgery cause hypoparathyroidism?

A
  • neck surgery can cause parathyroid to be damage
  • Commonest cause
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14
Q

Which is the most common syndrome to cause hypoparathyroidism?

A

Di George

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15
Q

What will the levels of PTH be like in hypoparathyroidism?

A

Low

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16
Q

What will the levels of calcium be like in hypoparathyroidism?

A

Low

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17
Q

What will the levels of phosphate be like in hypoparathyroidism?

A

High

18
Q

Is the action of PTH appropriate or inappropriate in hypoparathyroidism?

A

Inappropriate

19
Q

What is psuedohypoparathyroidism?

A
  • Resistance to parathyroid hormone
    • Receptors on organs don’t respond to PTH
    • Inherited
    • Type 1 Albright hereditary osteodystrophy
      • caused by mutation with deficient Gα subunit
20
Q

What are the signs of pseudohypoparathyroidism?

A
  • Short stature
  • Obesity
  • Round facies
  • Mild learning difficulties
  • Subcutaneous ossification
  • Short fourth metacarpals
  • Other hormone resistance
21
Q

What will the levels of PTH be like in pseudohypoparathyroidism (PTH resistance)?

A

High

22
Q

What will the levels of calcium be like in pseudohypoparathyroidism (PTH resistance)?

A

Low

23
Q

What will the levels of phosphate be like in pseudohypoparathyroidism (PTH resistance)?

A

High

24
Q

Is the action of PTH appropriate or inappropriate in pseudohypoparathyroidism (PTH resistance)?

A

Appropriate
- PTH acting normally, receptors resistant

25
Q

What may look like hypercalcaemia actually be instead?

A
  • Tourniquet on for too long
  • Sample old and haemolysed
26
Q

What are symptoms of hypercalcaemia?

A
  • Thirst, polyuria
    • Excess Ca
  • Nausea
    • Gut is a muscle, gut stasis
  • Constipation
  • Confusion → coma
27
Q

What could chronic hypercalcaemia lead to?

A
  • Renal stones
  • ECG abnormalities
    • Short QT
28
Q

What is 90% of hypercalcaemia caused by?

A
  • Malignancy
    • bone mets, myeloma, some
      tumours produce PTHrP,
      lymphoma
    • PTHrP acts like PTH
    • Lymphomas can activate
      vitamin D
  • Primary hyperparathyroidism
29
Q

What is 10% of hypercalcaemia caused by?

A
  • Thiazides
  • Thyrotoxocosis
  • Sarcoidosis
  • Familial hypocalciuric / benign hypercalcaemia
  • Immobilisation
    • Bone resorption
  • Milk-alkali
    • Usually in people with renal impairment
  • Adrenal insufficiency
  • Phaeochromocytoma
30
Q

What will the levels of PTH be like in hypercalcaemia of malignancy?

A

Low

31
Q

What will the levels of calcium be like in hypercalcaemia of malignancy?

A

High

32
Q

What will the levels of phosphate be like in hypercalcaemia of malignancy?

A

Depends

33
Q

Is the action of PTH appropriate or inappropriate in hypercalcaemia of malignancy?

A

Appropriate

34
Q

What are consequences of Primary Hyperparathyroidism?

A
  • Bones
    • Osteitis fibrosa cystica
    • Osteoporosis
  • Kidney stones
  • Psychic groans
    • confusion
  • Abdominal moans
    • Constipation
    • Acute pancreatitis
35
Q

What is 80% of Primary Hyperparathyroidism due to?

A

single benign adenoma
- can be treated by minimally invasive parathydroidectomy

36
Q

What is 15-20% of Primary Hyperparathyroidism due to?

A
  • four gland hyperplasia
    • All 4 glands overgrowing
    • may be part of MEN I or II
37
Q

What is <0.5% of Primary Hyperparathyroidism due to?

A

malignant

38
Q

What will the levels of PTH be like in Primary hyperparathyroidism?

A

High

39
Q

What will the levels of calcium be like in Primary hyperparathyroidism?

A

High

40
Q

What will the levels of phosphate be like in Primary hyperparathyroidism?

A

Low

41
Q

Is the action of PTH appropriate or inappropriate in Primary hyperparathyroidism?

A

Inappropriate

2a- Endocrinology (17 decks)

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