Flashcards in Parathyroid Deck (12):
Osteitis fibrosis cystica?
Lab values that's suggest primary hyperparathyroidism? Most likely cause? Management?
PTH and serum calcium
#Explore the neck and examine the parathyroid glands
#Sestamibi scan to determine site of adenoma (minimally invasive parathyroid surgery)
Most common location for missing inferior gland on parathyroid exploration?
Location of extra parathyroid gland?
Intrathyroidal, carotid sheath
On the initial exploration in a patient with primary hyperparathyroidism, unable to find adenoma. Next step?
#Localization studies – sestamibi, ultrasound, CT, MRI, angiography
Signs of hypoparathyroidism after surgery?
#Chovstek's sign (Tap facial nerve)
Asymptomatic patient with elevation in serum calcium – when to explore parathyroid?
Calcium over 11
Differential for causes of hypercalcemia?
Tumors – multiple myeloma, parathyroid adenoma/cancer, renal cell carcinoma, metastatic breast cancer, squamous cell cancer of the lung
Metabolic – hyperthyroidism, milk alkali syndrome, vitamin A intoxication
Inflammatory – sarcoidosis
Genetic – familial hypocalciuric hypercalcemia
secondary hyperparathyroidism mechanism?
Chronic renal failure causes retained phosphate. Hyperphosphatemia causes hypocalcemia. Elevated serum PTH
When to surgically manage secondary hyperparathyroidism?
Bone pain, fractures, pruritus, ectopic calcifications in soft tissue
Common operative findings in secondary hyperparathyroidism?
Hyperplasia all glands
Excision of all but 50 mg of parathyroid tissue parentheses leave in place, or implant in form)
Patient undergoes renal transplant and has hyperCalcemia postoperatively – parathyroid glands do not respond to return a renal function and continue to produce PTH
3 1/2 gland resection