Parathyroid Disease Flashcards
(22 cards)
A 48 yo female comes in to your office because she has recently had muscle weakness, joint pain, fatigue, nausea, appetite loss, and constipation. She tells you she also feels depressed and nervous. Two months ago this pt was treated for kidney stones, and five months ago she suffered a Colle’s fracture when she tripped and landed on her palm. What is the most likely underlying cause of this pt’s disease?
Primary hyperparathyroidism
Most likely caused by a parathyroid adenoma
A pt presents with polyurea, renal colic, bone pain, muscle pain, fatigue, confusion, headache, nausea, loss of appetite, and constipation. On exam you find that the pt is hypertensive and you hear heart arrhythmias. What is pathophysiology behind this pt’s disease? What are some likely causes of this disease?
Primary hyperparathyroidism PTH hypersecretion Parathyroid adenoma (MC, 85%) Parathyroid hypoplasia (15%) Parathyroid carcinoma (1%) Parathyroid cysts or MEN (rare)
What is the most common cause of elevated PTH and hypercalcia?
Primary hyperparathyroidism
A 52 yo female pt presents with bone pain, muscle weakness and pain, malaise, nervousness, and constipation. You suspect she has kidney stones and bone loss as well. What blood work results would you expect to see?
Primary hyperparathyroidism Elevated PTH! Hypercalcemia! Hypophosphatemia! Hypercalurea Elevated alkaline phosphates Vitamin D deficiency
When your pt is describing her symptoms, you start thinking “bones, stones, abdominal groans, psychiatric moans, and fatigue overtones”. What disease might this pt have? What diagnostic tests should you run?
Ultrasound (GOLD STANDARD) to look for an adenoma
CT or MRI
Non-contrast kidney CT
DEXA scan
A pt presented to you complaining of kidney pain, polyuria, a recent hip fracture, muscle weakness, joint pain, depression, nausea, vomiting, and constipation. Her blood work came back showing elevated PTH, elevated serum Ca, and low serum phosphate. Ultrasound showed a parathyroid adenoma. What is the best treatment option for this pt?
Surgery because the pt has symptomatic hyperparathyroidism
You ordered some blood work for you 85 yo female pt, and the results showed elevated PTH, hypercalcemia, and hypophosphatemia. You ordered an ultrasound which showed a parathyroid adenoma, but since it is asymptomatic and surgery would be risky for this pt, you and your pt decide not to pursue surgery. What 2nd line treatment should you recommend for this pt?
Medical therapy Fluids Vitamin D Estrogen IV bisphosphonates AVOID TZD's and Ca (risk of kidney stones) Try and keep the pt active and hydrated, avoiding immobility Monitor her labs frequently
A pt is brought to the ER because he is showing signs of renal failure. While taking his PMH, you discover that four months ago he suffered a vertebral fracture and that he has some bone pain. You order some blood work. What results do you expect to see?
Secondary hyperparathyroidism
Elevated PTH
Normal or low Ca
Hyper- or hypophosphatemia
During a routine work up for your pt, which included some blood work, you discover that she has elevated PTH, normal serum Ca, and hypophosphatemia. What other lab finding would you expect to see? What disease does this pt have? What is causing this pt’s disease?
Secondary hyperparathyroidism
Low Vitamin D
This pt either has vitamin D deficiency or abnormal vitamin D metabolism
A pt is brought to the ER for renal failure. His labs show elevated PTH levels, low Ca, and hyperphosphatemia. What caused this pt’s symptoms? What underlying disease does this pt have?
Secondary hyperparathyroidism
Caused by chronic renal insufficiency or renal failure
Pt most likely has an underlying renal disease
What are the causes secondary hyperparathyroidism?
PTH hypersecretion caused by a problem OUTSIDE of the parathyroid gland
Hypocalcemia or peripheral PTH resistance
Chronic renal insufficiency or failure (MC)
Vitamin D deficiency or malabsorption
Ca malabsorption
Medications that alter Ca or vitamin D absorption
You get the blood work results for you pt with chronic renal insufficiency and they show elevated PTH, normal Ca, and hyperphosphatemia. What other diagnostic tests should you order for this pt?
Non-contrast kidney CT
DEXA scan
Today you are seeing your pt with secondary hyperparathyroidism. She has failed medical therapy, so today you are meeting to talk about her other options. What treatment do you recommend? What should you warn your pt might happen with this treatment option?
Surgery
There is a 10% recurrence rate after surgery
Today you have a follow-up meeting with a 38 yo female pt. Last time she was here she was complaining of muscle cramps and tingling around her mouth (symptoms of hyperphosphatemia). After consulting with your supervising physician and an endocrinologist, you have decided on a diagnosis of secondary hyperparathyroidism. What treatment should you recommend this this pt at today’s visit?
Medical therapy Vitamin D supplements Phosphate binders Calcimimetics Treat the pt's hyperphosphatemia
A pt presents with muscle cramps, tingling in his hands, and stridor. You notice his right eye twitching, so you tap the angle of his jaw and find a positive Chvostek’s sign. What disease do you suspect in this pt? What is the pathophysiological cause this disease?
Acute hypoparathyroidism
PTH deficiency
A 65 yo male presents to your clinic. He is a chronic alcoholic with a 30 year pack history, and at today’s visit he is lethargic and anxious. He complains of blurry vision and thin, brittle nails. On exam you note hyperactive DTRs. What disease does this pt have? What has caused his disease
Chronic hypoparathyroidism
Caused by his chronic alcoholism
A pt with SLE (lupus) presents with muscle spasms, muscle cramps, tingling in her hands and feet, and a positive Chvostek’s sign. What disease does she likely have?
Acute hypoparathyroidism
A pt presents with muscle spasms, muscle cramps, carpopedal spasms, and is irritable. While taking her blood pressure you find she has Trousseau’s phenomenon. What could have caused her current disease?
Acute hypoparathyroidism
Acquired: post-thyroidectomy or parathyroidectomy
Autoimmune: alone or w/ other endocrine disease (Lupus)
Functional: malabsorption, chronic alcoholism, vitamin D deficiency
Miscellaneous: heavy metal damage, granuloma, infection, tumor
Two days ago a 66 yo female came in to your office because she had recently felt lethargic, had tremors, slow movements, and impaired speech. You were concerned that she has chronic hypoparathyroidism, so you send her to get some blood work done. What results do you expect to see?
Hypocalcemia
Hyperphosphatemia
Low PTH
Low urinary Ca
You suspect your pt has acute hypoparathyroidism and the blood work you ordered results are below. What other diagnostic tests would you perform on this pt?
Low serum Ca
Elevated serum phosphate
Low PTH
X-Ray/CT to look for basal ganglia calcifications, dense bones, and cutaneous calcifications
Slit lam exam to look for cataracts
EKG to look for a prolonged QT and and abnormal T wave
DEXA scan do look for increased bone mineral density
A pt presents with severe muscle tetany, loud stridor at rest, and seizures. You find the pt has a positive Chvostek’s sign and Trousseau’s phenomenon. What is most likely wrong with the pt? How will you treat it?
Acute hypoparathyroidism attack (EMERGENCY CONDITION)
Maintain an open airway
Give the pt IV and (if possible) oral Ca, vitamin D, and magnesium
Consider transplanting cryopreserved parathyroid if that is an option
Your pt comes in for a follow-up after seeing you just a few days ago for her regular annual physical. Because she mentioned that she was irritable an felt that her mental status might be altered, you ordered some blood work, with the results below. What treatment do you recommend for this pt?
Hypocalcemia
Hyperphosphatemia
Low PTH
Maintain her serum Ca levels
Start her on vitamin D supplements
Giver her a subcutanous PTH injection
Avoid medications that will deplete her Ca levels
