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Clin Med-Endocrine > parathyroid > Flashcards

parathyroid Flashcards

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1
Q

What is the role of PTH

A

single most important factor in regulation of serum calcium
regulated by level of ionized calcium
major target is kidney and bones

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2
Q

what is the action of PTH on the kidneys

A

increases renal calcium resorption in the tubules
increases phosphate excretion by blocking reabsorption
increases the conversion of Vit D to its active form in the kidneys which increases GI absorption of calcium

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3
Q

what is the function of PTH in the rapid phase of calcium homeostasis

A

PTH binds to receptors on the osteoblast and osteoclasts the membrane pumps Ca from the bone fluid which is transported into blood stream

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4
Q

what is the function of PTH in the slow phase of calcium homeostasis

A

osteoclasts are activated and breakdown formed bone which results in an increase in osteoclastic activity causing calcium to be released into the blood stream increasing Ca levels

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5
Q

where is the majority of calcium stored?

A

99% is in the bone

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6
Q

what percent is free

A

40%

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7
Q

what percent is bound to plasma

A

50%

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8
Q

where is vitamin D-3 cholecalciferol former

A

is formed in the skin with exposure to UV light and Vitamin D-2 is absorbed in our diet

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9
Q

Where is Vitamin D-3 activated when it undergoes hydroxylation

A

in the liver and the the kidney into its active form. Need to be activated in the kidneys in response to PTH stimulation due to low serum calcium levels and low phosphate levels

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10
Q

What is the primary action of D-3

A

is to promote intestinal absorption of calcium and phosphate and enhances bone absorption of Ca

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11
Q

As Ca levels increase what happen to PTH secretion, renal vitamin D activation, intestinal Ca absorption and renal phosphate reabsorption?

A

PTH decreases
Renal Vit-D act decrease
intest Ca abs decreases
Renal phosphate increases

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12
Q

where is majority of phosphate located

A

in bone

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13
Q

what does phophate exist as in the blood

A

phopolipids and phosphate esters and inorganic phosphate(ionized)

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14
Q

what is the function of phophate

A

acts as intra/extracellular anion buffer of the regulation of acid base balance
provides energy for muscle contraction in ATP

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15
Q

what is the function of calcitonin

A

decreased ECF calcium levels

it gets stimulated by large increases in plasma Ca levels

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16
Q

What are the targets that calcitonin acts on

A

bone: inhibits resorption by inhibiting osteoclasts
kidney: stimulates calcium and phosphate excretion in renal tubules

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17
Q

what are the 3 hormones that regulate calcium phosphate balance

A

PHT, Calcitonin and vitamin D
control absorption in intestines
controls deposition and absorption of Ca/P from bone
controls renal reabsorption and excretion of Ca/P by the kidney

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18
Q

what is the definition of hyperparathyroidism

A

abnormal hypersecretion of PTH secretion

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19
Q

what are the results of having hyperparathyroidism

A

hypercacemia hypophosphatemia (hallmark finding)

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20
Q

What happens when there is excessive PTH released what are the problems this can have with parts of the body?

A

wrist and hip fractures due to calcium loss, cystic bone lesions, kidney stones due to hypercalciuria, slowing of the nervous system and musculoskeletal system

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21
Q

what is the most common cause of elevated PTH and hypercalcia?

A

primary hyperparathyroidism

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22
Q

who are are the highest risk for hyperparathyroidism

A

people older than 40

more common in females

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23
Q

what is the most common etiology of primary hyperparathyroidism

Study These Flashcards
A

parathyroid adenoma

24
Q

what are other causes of hyperparathyroidism

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A

parathyroid hyperplasia

parathyroid carcinoma

25
what is secondary hyperparathyroidism
compensatory hyper-functioniong of the parathyroid glands caused by hypocalcemia or peripheral resistance to PTH
26
what is the hallmark of secondary hyperparathyroidism?
elevated PTH, normal to low calcium levels and high renal disease to low vitamin D absorption low phosphate levels
27
what is the most common cause of secondary hyperparathyroidism
chronic renal insufficiency/failure
28
what are other causes of secondary hyperparathyroidism
Vit-D deficienct or abnormal vit D metabolism calcium malabsorption medications (phenytoin, phenobarbital, laxitives)
29
what are signs and and symptoms of primary hyperparathyroidism
hypercalcemia is detected by accidental blood work | most pts are asymptomatic of have mild symptoms that might be discovered in ROS
30
what are things you might expect to see with primaryPTH in the kidney/urinary tract?
nephrolithiasis (kidney stones) polyuria, renal colic
31
what are things you might expect to see with primaryPTH in the skeletal system?
bone loss, fractures, bone pain, muscle weakness, myalgias, arthralgias
32
what are things you might expect to see with primaryPTH in the neuromuscular?
muscle weakness, fatigue/malaise
33
what are things you might expect to see with primaryPTH in the neurologic?
depression, nervousness, cognitive dysfunction, physchosis, confusion, headache
34
what are things you might expect to see with primaryPTH in the GI?
peptic disease, pancreatitis, cholelithiasis, N/V, loss of appetite, constipation, abdominal pain
35
what are things you might expect to see with primaryPTH in the Cardio?
HTN, arrhythmias
36
what is the most common presentation of 2nd hyperparathyroidism
renal failure,
37
what are other symptoms of hyperparathyroidism
weaking of bones, fractures, bone pain | heart arrythmias
38
what are the lab values like for primary hyperparathyroidism
Hypercalcemia>10.5mg/dl Serum phosphate low<2.5mg/dl elevated PTH
39
what are the lab values like for secondary hyperparathyroidism
serum phosphate is high in kidney failure and low if due to absorption problems elevated serum PTH normal serum calcium
40
what is the treatment for primary hyperparathyroidism
1st line is surgery | 2nd line is medial therapy
41
When is medical therapy used in patients
pts who are not candidates for surgery | or asymptomatic patients
42
how is a person with hyperparathyroidism managed
fluids to treat hypercalcemia bisphosphonate IV (lowers serum calcium) Vit-D supplemetation
43
what are things you want to avoid with primary hyperparathyroidism
Thiazides diuretics, calcium supplements
44
what are things you may want to encourage your patients to do to help with hyperparathyroidism
staying active, hydrated, avoid immobilization
45
how do you treat a person who has secondary hyperparathyroidism
``` treat underlying condition Medical therapy is mainstay Vitamin D supplementation (reduce PTH levels, but may also increase calcium level and contribute to caciphylaxis phosphate binders Cacimimetics ```
46
what are calcimimetics
attach to a receptor on parathyroid cells and increase the ability of the cells to recognize high calcium levels in the bloodstream so less PTH is made decreases the amount of calcium in the blood
47
what is the next treatment if medical therapy fails
surgical therapy
48
what percent of asymptomatic patients will develop worsening hypercalcemia, hypercalciuria, and reduced bone density
1/3
49
what is hypoparathyroidism
condition where the body does not produce enough PTH and hypocalcemia happens
50
What are some causes of hypoparathyroidism
``` thyroidectomy autoimmune functional due to malabsorption, alcoholism, vitamin D deficiency congenital exposure to heavy metals ```
51
what are acute signs of hypoparathyroidism
``` tetany muscle cramps carpopedal spasm Irritability altered mental status convulsions stridor tinglining around mouth, hands, feet chvosteks sign trousseaus phenomenon ```
52
what are chronic signs of hypoparathyroidism
``` lethargy personality changes anxious blurred vision parkinsonism metal retardation nails thin and brittle skin dry and scaly loss of eyebrows ```
53
what is the trousseaus phenomenon
carpal spasm after application of a BP cuff
54
what are the lab values like for hypoparathyroidism
serum calcium low serum phosphate is high PTH level low Urinary calcium low
55
what are abnormal imaging/special tests for hypoparathyroidism
calcification of basal ganglia bones may be denser than normal, cutaneous calcification cataracts ECG changes- prolonged QTinervals T wave abnormalitie increased bone mineral density
56
how to treat acute attacks of hypoparathyroidism
``` maintain open airway IV calcium gluconcate oral calcium Vit-D magnesium transplantation of cryopreserved parathyroid tissue ```
57
What is the long term treatment for hypoparathyroidism
maintain serum calcium between 8-8.6mg/dl vitamin D supp PTH injection avoid calcium depleting drugs(phenothiazine, furosemide)

Clin Med-Endocrine (8 decks)

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