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ClinMed exam III > Parathyroid > Flashcards

Parathyroid Flashcards

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1
Q

What regulates calcium in the body?

A
  • PTH
  • calcitonin
  • active vitamin D
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2
Q

What body systems utilize calcium?

A
  • nervous
  • muscular
  • skeletal
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3
Q

Where is most of the body’s calcium stored

A

in the bones (99%)

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4
Q

What are the three forms of calcium that circulate in the blood

A
  • free ionized form (active)
  • bound to protein
  • complex aniions
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5
Q

What is the normal total serum calcium

A

8.5-10.5 mg/dL

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6
Q

What is the net effect of parathyroid hormone

A
  • increase serum calcium

- decrease serum phosphate

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7
Q

What is the active form of vitamin D

A

calcitriol

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8
Q

Net effect of calcitriol

A
  • increase serum calcium

- increase serum phosphate

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9
Q

What does calcitriol do in the intestine

A

enhances intestinal cells to absord calcium and phosphate into the serum

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10
Q

Body response to low serum Ca in the bone? kindey?

A

bone: PTH stimulated osteoclastic activity which leads to increased serum CA
kidney: PTH promotes Ca resorption and stimultes hydroxylation of 25-hydroxyvitamin D via an enzyme

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11
Q

Body’s response to high serum Ca

A

parathyroid decreases PTH production

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12
Q

PTH response to increased serum calcium

A

PTH levels decrease

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13
Q

PTH response to decreased serum calcium

A

PTH levels increase

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14
Q

What does PTH do in the bone

A
  • activates osteoclastic activity to increase serum calcium

- inhibits osteoblastic activity

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15
Q

What does active vitamin D do in the bone

A

promotes osteoblactic activity

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16
Q

What does calcitonin do in the bone

A

activates osteoblastic activity to decrease serum calcuim

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17
Q

What does the kidney do to maintain calcium homeostatsis

A
  • reabsorbs calcium
  • secretes phosphate in the urine
  • increases serum alpha hydroxylase in order to convert calcidiol into calcitriol
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18
Q

Most common cause of hypocalcemia in adults

A

renal failure

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19
Q

Most common cause of hypocalcemia in children

A

nutritional deficiencies

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20
Q

Average age of hypoparathyroidism diagnosis

A

5th decade

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21
Q

Why is hypocalcemia from hypoparathyroidism rare

A

it requires all 4 parathyroid glands to be affected

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22
Q

Etiology of hypoparathyroidism

A 
PARATHYROIDECTOMY
THYROIDECTOMY
-extensive raditation to neck
-autoimmune
-congenital
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23
Q

Symptoms of hypocalcemia

A
  • emotional lability
  • paresthesia
  • shortness of breath
  • voice changes
  • vision changes
  • personality changes
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24
Q

Physical exam findings with hypocalcemia

A
  • seizures
  • arrhythmia
  • stridor
  • tetant
  • psychosis
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25
What is Trousseau sign
flexion of the wrist and fingers
26
What is chvotek sign
abnormal reaction of the cranial nerves to stimulation on the face
27
What diagnostics are done for hypocalcemia? what do they show?
- EKG: qtc prolongation - Total calcium (corrected calcium for low albumin): low - PTH: low
28
Measuring calcidiol levels looks for what
liver dysfunction
29
What levels do you measure for kidney dysfunction
active vitamin D (calcitriol)
30
Treatment for hypocalcemia
- oral calcium (calcium carbonate) | - IV calcium (calcium gluconate)
31
What is the most common electrolyte abnormality in adults with malignancies
hypercalcemia
32
What is the most common cause of hypercalcemia
hyperparathroidism
33
What oncogene is linked to hyperparathyroidism
MEN 1, 2A and 2B
34
Etiologies for hypercalcemia
``` S.H.A.M.P.O.O sarcoidosis hyperparathyroid alkali milk syndrome metastasis pagets disease osteogenesis imperfecta osteoperosis ``` ``` D.I.R.T d vitamin intoxication immobility renal tubular acidosis thiazides ```
35
Eitology of primary hyperparathyroid
- parathyroid adenoma - hyperplasia - carcinoma - familial hypocalciuric hypercalcemia
36
Etiology of secondary hyperparathyroid
- chronic renal failure | - vitamin D deficinecy
37
Signs and symptoms of hypercalcemia
"bones, stones,groans, moans, psychiatric undertones"
38
``` Exam findings for hypercalcemia. skin cardiac GI renal MSK Neuro ```
*exam is usually non contributory* skin: prutitus, skin tenting cardiac: hypertension, LVH GI: anorexia, N/V, constipation, abd pain Renal: renal colic MSK: bone fracture Neuro: paresthesias, muscle weakness, depression
39
Diagnostic tests for hypercalcemia/hyperparathyroid
- calcium level - PTH - 24hr urinary calcium excretion - chloride, phosphate - PTHrP (malignancy) - Bun/creatinine - calcitriol/calcidiol - EKG (narrow qtc)
40
Calcium, PTH and phosphate levels in primary hyperparathyroid
calcium- high PTH- high phosphate- low
41
Calcium, PTH and phosphate levels in secondary hyperparathyroidism
calcium- low to normal PTH- high phosphate- high to normal
42
Calcium, PTH and phosphate levels in secondary hyperparathyroidism
calcium- high PTH- super high phosphate- high
43
PTH release is increased by
- hypocalcemia - hyperphosphatemia - catecholamines
44
PTH is release is suppressed by
- hypercalcemia - vitamin D - severe hypomagnesemia
45
Scans done for hyperparathyroidism
- sestamibi scan | - US of the neck
46
Treatment options for hyperparathyoidism
- surveillance - surgical - pharmacological - supportive
47
Medical treatment for hyperparathyroid
ASYMPTOMATIC PTS - hydrate, avoid immobilization - modest dietary calcium - bisphosphonates - d/c thiazides, vitamin A, calcium containing antacids
48
What is required for asymptomatic patients with hyperparathyroidism
annual serum calcium and creatinine bone density scans every 1-2 years
49
What makes someone a surgical candidate for hyperparathyroidism
- symptomatic - under the age of 50 - pregnant - CrCl <60 - 24 hr urine calcium >400 - presence of nephrocalcinosis - osteoperosis
50
Medications for treatment of hypercalcemia
- normal saline (dilution) - loop diuretics w/ increased hydration - bisphosphonates (inh osteoclastic) - calcitonin (inh osteoclasts, promotes osteoblasts) - gallium nitrate (direct inh of bone resorption)
51
Bisphosphonates used for hypercalcemia
- pamidronate | - zoledronic acid
52
Most common symptoms of hyperparathyroid
- nephrolithiasis - fatigue - bone disease
53
Genetic predisposition for parathyroid cancer
MEN1 and 2A
54
When is parathyroid cancer suspected
if symptoms are severe - Ca levels >14 - PTH 5x normal - palpable parathyroid
55
Treatment of parathyroid cancer
bilateral neck exploration with excision of tumor and ipsilateral thyroid lobe
56
How to treat parathyroid cancer with nodal involvement
radical neck dissection
57
When to check Ca levels after parathyroid cancer surgery
- 2 weeks post op - 6 months - anually
58
What is pagets disease
localized disorder of bone remodeling with excessive bone resorption followed by disorganized bone formation
59
What are the three phases of paget disease
1. lytic 2. mixed 3. sclerotic phase
60
What happens during the lytic phase of paget disease
osteoclasts are more numerous and larger than normal HIGH bone turnover
61
What happens during the mixed phase of paget disease
rapid increase in bone formation from numerous osteoblasts
62
What happens during the sclerotic phase of paget disease
bone if formed in a disorganized, woven pattern and is therefor weaker than normal hypervascular bone state
63
Most common symptoms of paget disease
PAIN - pathologic fracture - osteoarthritis - nerve impingement - hearing loss
64
How is paget disease often diagnosed
accidentally by radiography or elevated alk phos
65
Treatment for paget disease
- surveillance for asymptomatic pts - bisphosphonates - calcitonin (intolerant to bisphosphonates) - calcium - vitamin D
66
Which bisphosphonates are used for paget disease
- zolendronic acid - pamidronate - risendronate - alendronate
67
Preferred bisphosphonate for extensive disease or the elderly
IV zolendronic acid
68
Preferred disphosphonate for less extensive disease/young patients
risendronate or alendronate

ClinMed exam III (7 decks)

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