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parathyroid Flashcards

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1
Q

PTH 3 functions

A
  • mobilize calcium from bones by osteoclast stimulation
  • stimulates kidneys to resorb calcium
  • increases GI absorption of calcium
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2
Q
  • what causes 85% of primary hyperparathyroidism

- other 15%

A
  • benign parathyroid gland adenomas

- parathyroid gland hyperplasia

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3
Q

hyperparathyroidism

  • gender
  • age
A

women 2:1 ratio

incidence increases after age 50

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4
Q

what occurs with chronic kidney disease and why

A

secondary hyperparathyroidism occurs due to hyperphosphatemia, causing increased ionized calcium levels, and decreased renal production of active vitamin D

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5
Q

mild hypercalcemia symptoms

A

asymptomatic

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6
Q

thirst, anorexia, depressed DTR, N/V, abd pain, constipation, fatigue, anemia, wt loss, peptic ulcer disease, pancreatitis, HTN

A

severe hypercalcemia symptoms

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7
Q

stones, bones, groans, moans

A
  • renal loss of Ca and phosphate= kidney stones
  • bone loss from PTH= pain in bones
  • increase GI absorption and abd cramps= groans
  • irritability, psychosis, depression= moans
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8
Q

pathologic fractures occur where usually

A

jaw

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9
Q

hypercalcemia induced nephrogenic diabetes insipidus symptoms

A

polydipsia and polyuria

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10
Q

hypercalcemia in relation to urine calcium

A

urine calcium excretion is low for hypercalcemia

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11
Q

what labs confirm hyperparathyroidism

A

elevated serum levels of intact PTH

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12
Q

what labs confirm a secondary disorder of PTH such as malignancy

A

elevated calcium with low PTH

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13
Q

what labs indicate parathyroid cancer

A

extreme elevations of both calcium and PTH

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14
Q

what to do before treating hyperparathyroidism

A

screen for familial benign hypocalciuric hypercalcemia with a 24 hr urine for calcium and creatinine

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15
Q

pts with low bone mineral density, normal serum calcium, elevated PTH

A

should be assessed for secondary hyperparathyroidism from vitamin D or calcium deficiency, hyperphosphatemia, or renal failure

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16
Q

EKG with hyperparathyroidism

A

prolonged PR interval, shortened QT interval, bradyarrhymias, heart block, asystole

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17
Q

treatment for mild asymptomatic primary hyperparathyroidism

A

stay active, avoid immobilization, drink adequate fluids

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18
Q

hyperparathyroidism pts should avoid what

A

thiazides, large doses of vitamin A and D, and calcium containing antacids, and supplements

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19
Q

monitor hyperparathyroidism with what tests

A 
serum calcium
serum albumin
kidney function
urinary calcium excretion
bone density studies
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20
Q

what can temporary measure to decrease serum calcium

A

bisphosphonates; with cautious administration of vitamin D

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21
Q

acute hypercalcemic crisis

A

IV hydration and bisphosphonates; furosemide may promote urinary calcicum excretion

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22
Q
  • tx for symptomatic primary disorder-hyperparathyroidism

- what can occur post operatively

A
  • parathyroidectomy

- hypocalcemia and transient hyperthyroidism may occur post op

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23
Q

hypercalcemia symptoms

A

proximal muscle weakness, gait disturbances, atrophy, hyperreflexia

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24
Q

acquired hypoparathyroidism most commonly from what

A

following parathyroidectomy or thyroidectomy

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25
heavy metal toxicity can cause what
hypoparathyroidism
26
hypomagnesium can cause what
hypoparathyroidism
27
What is DiGeorge syndrome
congenital cause of hypocalcemia arising from parathyroid hypoplasia, thymic hypoplasia and outflow tract defects of the heart
28
congenital pseudohypoparathyroidism results from what
a group of disorders characterized by alterations in serum calcium related to resistance to PTH
29
tetany, carpopedal spasms, mm or abd cramps, paresthesias as well as teeth, nail, and hair defects, HYPERreflexia
hypocalcemia
30
hypocalcemia signs
tetany, carpopedal spasms, mm or abd cramps, paresthesias as well as teeth, nail, and hair defects, HYPERreflexia
31
chvostek sign
contraction of eye, mouth, nose muscles, elicted by tapping along the course of the facial nerve anterior to the ear
32
trosseau sign
produces spasm in the hand and wrist with compression to the forearm
33
lethargy, anxiety, parkinsonism, mental retardation, personality changes, blurred vision caused by cataracts
severe chronic hypoparathyroidism
34
hallmark to hypoparathyroidism
decreased PTH and adjusted serum calcium, and increased phosphate levels [serum magnesium may be low, alk phos nml]
35
EKG in hypoparathyroidism
prolonged QT intervals and t wave abnormalities
36
radiographs in hypoparathyroidism
chronic increased bone mineral density, especially in the lumbar spine and skull
37
hypoparathyroidism tx
correct hypocalcemia with Ca and Vit D. Mag supp may be required
38
how to monitor tx of hypoparathyroidism
measurement of adjusted serum and urine calcium levels
39
avoid what drugs with hypoparathyroidism
phenothiazines and furosemide due to risk of further calcium loss
40
what is emergency tx of tetany
airway maintenance and slow administration of IV calcium gluconate
41
An adenoma of the parathyroid does what
An adenoma leads to excessive secretion of parathyroid hormone.
42
Chronic renal failure and poor production of vitamin D which will cause what
Chronic renal failure and poor production of vitamin D which will decrease Calcium, thereby stimulating the parathyroid glands
43
hyperparathyroidism | Blood work
Ca > 10.5 elevated PTH is diagnostic phosphate low less <2.5 in primary disease. Elevated in secondary disease low vitamin D
44
hyperparathyroidism | Urine
Ca elevated | phosphate elevated
45
hyperparathyroidism | Imaging
- CT/ MRI not helpful - U/S is far more sensitive though not necessary - X-ray: demineralization subperiosteal bone resorption especially in the fingers cysts of the jaw; salt and pepper skull - DXA scan may help determine amount of bone loss
46
hyperparathyroidism surgical tx
Surgical removal 94% successful | parathyroidectomy is the recommended treatment for symptomatic and some asymptomatic patients
47
complication of parathyroidectomy
hypocalcemia
48
Hyperthyroidism and hyperparathyroidism
Hyperthyroidism may result from physical manipulation of the thyroid- propranolol if necessary
49
Medical treatment of hyperparathyroidism
Fluid, Fluid, Fluid — admission and IV fluid if necessary IV Bisphosphonates Pamidronate Zoledronic Acid Cinacalcet — a calcimimetic Vitamin D Estrogen decreases serum Ca in a postmenopausal hyperparathyroidism Propranolol may be used to protect the heart against elevated Ca
50
``` Heavy metal damage Low Mg Granulomas Tumors Infection Reidel’s thyroiditis Post thyroidectomy is the most common Post parathyroidectomy ```
can all cause hypoparathyroidism
51
Autoimmune hypoparathyroidism
may occur alone in combination with other autoimmune disorders like lupus or Addison’s disease.
52
``` irritability tetany — the involuntary contraction of muscles carpopedal spasms cramping convulsions tingling circumoral distal extremities ```
acute hypoparathyroidism
53
``` Lethargy parkinsonism mental retardation anxiety changes in personality cataracts → blurred vision dry skin decreased eyebrow hair Nail and teeth defects — brittle nails hyperreflexia (possible) ```
chronic hypoparathyroidism
54
``` Ca low Corrected Ca will be low (Ca is mostly bound to albumin so if albumin is low you need a corrected Ca) Urinary Ca low Parathyroid hormone is low Mg low ```
hypoparathyroidism
55
- CT or x-ray may show dense bones cutaneous calcifications, calcifications of basal ganglia - EKG: prolonged QT, T wave abnormalities - Slit-lamp: early cataract formation
hypoparathyroidism
56
hypoparathyroidism treatment
Emergently: airway maintenance and IV calcium gluconate Followed by: Mg if appropriate Ca supplement Vitamin D supplement Close monitoring of Ca
57
pseudohypoparathyroidism
In pseudohypoparathyroidism you make parathyroid hormone, but the receptors don’t respond to it.
58
pseudohypoparathyroidism Blood work
Ca will be low | Parathyroid hormone is elevated
59
pseudohypoparathyroidism treatment
Cases are typically not as severe as true hypoparathyroidism Ca supplement Vitamin D supplement
60
X-ray: salt and pepper skull; demineralization subperiosteal bone resorption especially in the fingers cysts of the jaw
hyperparathyroidism
61
hyper or hypoparathyroidism can cause cataracts
hypo- do slit lamp
62
QT interval for hyper and hypoparathyroidism
hyper is shortened | hypo is prolonged
63
hyper and hypoparathyroidism | which has t wave abnormalities, bradyarrhythmias, hrt block, asystole?
hypoparathyroidism has t wave abnormalities | hyperparathryroisim has bradyarrhythmias, hrt block, and asystole

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