Hyper Parathyroidism - HPT

Question 1

Hyper parathyroidism is a result of

Answer 1

increased blood level of parathyroid hormone

Question 2

Explain Primary HPT

• what causes it
• Is it a major cause of hypercalcimia

Answer 2

Involves the gland itself
Stimulated to secrete more parathyroid hormone
Most commonly a benign adenoma, carcinoma, hyperplasia, ectopic tumors, hyper CA and hypophosphatemia

Question 3

Explain Secondary HPT

Answer 3

Abnormal stimulation of the glands by sustained HYPOCALCEMIA predominantly from renal disease 
- loss of Ca++ and decrease in Vit. D
- low normal hypocalcemia and hyperphosphatemia
Can be caused by:
-Chronic renal disease
- malabsorption
- serum calcium is low or low normal 
- Phosphorous is elevated
- associated with renal osteodystrophy

Question 4

What occurs in renal osteodystrophy

Answer 4

Elected phosphorous can lead to soft tissue calficiation - which can even lead to bone osteosclerosis

Question 5

Explain Tertiary HPT

Answer 5

Long standing secondary HPT with chronic renal failure or malabsorption
Parathyroid function may become autonomous - can relate to ectopic tissues
paraneoplastic syndrome
May have hypercalcemia
Only been around for 20 years

Question 6

What is the function of parathyroid hormone

Answer 6

Increase in osteoclastic and osteocytic stimulation
- Ca++, phosphorus and osteoid are all broken down
Osteoblastic inhibition
Renal conversion of calcium an dinhbition of phosphate resorption
Renal stimulation of 1-alpha-hydroxylase, causing increased formation of 1, 25 Vit D
Indirect efect on GI absorption

Question 7

Once Ca++ serum goes down the parathyroid starts to stimulate parathyroid hormone - tells the osteoclasts and osteocytes to get to work and work harder - the renal will start to dump ca++ because kindle can not conserve ca+ - excessive parathyroid stimulation will ultimately have us

Answer 7

loose bone density

Question 8

Calcitonin is secreted by

Answer 8

the human thyroid - c cells or parafolicular cells

Question 9

Calcitonin is regulated by

Answer 9

serum calcium level

Question 10

Calcitonin inhbits

Answer 10

bone resorption by osteoclastic function and may lead to hypocalcemia and hypophosphatemia
Inhibits GI calcium absorption
Stimulates osteoblastic activity
Inhibits renal tubular cells reabsorption of calcium

Question 11

Why is calcitonin important in humans?

Answer 11

is the normal regulation of normal calcium homeostasis

Question 12

Histopathic changes in HPT include…

What are common disease names related?

Answer 12

osteoclastic and osteocytic bone resorption with fibrous tissue replacement
Osteitis fibrosa cystica
Recklinghausen’s disease of bone

Question 13

Major bone changes in HPT include

Answer 13

Osteopenia
accented trabecular pattern
loss of cortical definition
Brown tumors

Question 14

What bone change is unique to HPT? Explain it

Answer 14

Brown tumors: Subperiosteal bone resorption

Question 15

What is the male and female ratio for HPT? What age range?

Answer 15

Female 3: 1 males - 30 - 50 years old

Question 16

Symptoms of HPT usually related to what three structures?

Answer 16

Bone, renal, GI

Question 17

Symptoms/signs of HPT include

Answer 17

weakness (hypercalcemia), lethargy, polydipsia, pyuria, renal calculi (kidney stones), bone tenderness
Sub-periosteal bone resorption

Question 18

Where in the body is it common to see Tertiary HPT

Answer 18

In the hands

Middle phalanges radial aspect (thumb) 2nd - 4th digits pathognomonic

Question 19

Where does inter cortical bone resorption occur?

Answer 19

within haversian canals, linear striations/porous looking

Question 20

Where does endosteal bone resorption occur?

Answer 20

Typically hand and with other findings

Question 21

Where does subchondral bone resorption occur?

Answer 21

Common in SI, SC, AD, symphysis pubis and disco vertebral junctions - can mimic inflammatory joint disease
ex) SI joint sacrolilits

Question 22

Tertiary HPT are against

Answer 22

Joints - they get up under the articulation

Question 23

DRA stands for

Answer 23

Dialysis related athropathy

Question 24

DRSA means

Answer 24

Dialysis related spondyloarthropathy

Question 25

What does the trabecular bone resorption look like in tertiary HPT?

Answer 25

Diffuse in skeleton, very prominent in cranium - cause very granular appearance to diploid space - salt and pepper skull

Question 26

Sub-ligamentous bone resorption at enthuses can occur in terry HPT this can happen at the sites of:

Answer 26

Trochanters, ischial and humeral tuberosity, elbow, calcaneus, inferior distal end of clavicle

Question 27

Explain Brown tumor/osteoclastoma

Answer 27

Localized cyst-like bone resorption containing fibrous tissue, giant cells and hemorrhage "brown" color is histopahtoligc * tumor like disorder

Question 28

Acro osteolysis

Answer 28

Distal tuft resorption, seen with many other conditions - all RA, psoriatic arthritis, scleroderma, burn/frostbie victims, gout

Question 29

Densities might find HPT T/F

Answer 29

True

Question 30

Chondrocalcinosis

Answer 30

Calcification of articular cartilage - maybe hydroxyapatite or CPPD (calcium pyrophosphate dehydrate)

Question 31

Rugger-Jerse Spine may be related to ______. And is found in which type of HPT

Answer 31

Hyperphosphatemia | Secondary

Question 32

Osteosclerosis and periostitis is most commonly founding what HPT and rarely in what HPT?

Answer 32

Commonly found in secondary | Rarely found in primary

Question 33

Chondrocalcinosis and brown tumors are most commonly found in what HPT and rarely in what HPT?

Answer 33

More commonly founding primary | Rarely found in secondary

Question 34

Combination of secondary HPT + osteomalacia + soft tissue and vascular calcification is termed

Answer 34

Renal osteodystrophy/uremic osteopathy

Question 35

PHP - Etiology - define - characteristics - X-ray findings

Answer 35

Genetic disorder Related to end organ resistance to parathyroid hormone with normal Ph production Characteristics: short stature, obesity, round face, brachydactyl, Xray: similar to hypoparathyroidism, hypocalcemia and hyperphosphatemia *have it but do not respond to it

Question 36

PPHP - etiology - what makes it different from PHP

Answer 36

genetic Similar to PHP has normal Ca++ and phosphorous

Question 37

Hypoparathyroidism

Answer 37

Defieicniy of PTH most commonly from excision or trauma to the PTG during thyroidectomicies - seen in

Question 38

Signs of hypoparathyroidism?

Answer 38

``` Bone osteosclerosis thickening of the cranial vault bones calcification of the basal ganglia rarely choroid plexus and cerebellum Rare spine changes: pain, stiffness with calcification of ALL and posterior spinal ligaments - resembling DISH ```

Question 39

Etiology of Hypoparathyroidism

Answer 39

Acquired

Question 40

Neoplasm in children is most likely

Answer 40

Leukemia

Question 41

Neoplasm in adults is most likely

Answer 41

Non-Hodgkins

Question 42

T/F neoplasm is often seen with anemia

Answer 42

True