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FA17 Endocrine > Parathyroid Disease > Flashcards

Parathyroid Disease Flashcards

(58 cards)

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1
Q

calcium funciton

A

human skeleton

regulates degree of membrane excitability in nerve cells and muscle cells of GI and heart

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2
Q

nerve cells and hypercalcemia

A

cells are refectory to stimulation

hard to get the nerves excited

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3
Q

nerve cells and hypocalcemia

A

patients develop tetany or carpopedal spasm

nerves are very excitable

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4
Q

calcium levels in blood

A

9.5 mg/dL

half is bound to serum protein, half is ionized and active

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5
Q

calcium homeostasis maintained by

A

kidney, intestines, bones

hydroxylated vitamin D and parathyroid hormone

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6
Q

calcium palace in body

A

sensed by parathyroid and secretion of PTH increases

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7
Q

PTH immediate effects

A

stimulates kidney to hold on to calcium and bones to release calcium quickly bump up serum levels

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8
Q

PTH long term

A

PTH stimulates more absorption of calcium from gut by stimulating kidney to secrete vitamin D which acts at the gut receptor to increase calcium absorption

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9
Q

vitamin D

A

dietary intake or UV rays

biologically inert and must be hydrolyzed in body

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10
Q

vitamin D hydroxylation

A

skin/GI vitamin D

then goes to liver where it becomes 25-hydroxy-vitamin D (calcidiol)

finally goes to kidney where it goes to active 1,25-dihydroxy (calcitrol)

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11
Q

what do we use to measure vitamin D status

A

serum concentration of 25(OH)D

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12
Q

vitamin D toxicity

A

can cause non-specific s/s such as anorexia, weight loss, polyuria, and heart arrythmias

can raise blood levels calcium which leads to vascular and tissue calcification

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13
Q

calcium and the bones

A

bone balance is stimulated by exercise, anabolic, and anti-resorptive drugs

conditions that promote bone formation over bone resorption

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14
Q

effect of PTH (4)

A
  1. stops calcium excretion and promotes urinary phosphate excretion
  2. stimulates kidney to produce vitamin D
  3. activation of ostoeCLASTS
  4. stops activation of osteoBLASTS
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15
Q

normal calcium values

A

9-10.5 mg/dL

ionized levels - 4.5-5.6

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16
Q

severe calcium values

A

> 14 mg/dL

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17
Q

correct Ca

A

serum binding proteins (albumin) can cause falsely elevated levels

(Ca + 4) - albumin

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18
Q

what influences symptoms of high or low Ca

A

severity of derangement (farther from normal)

speed

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19
Q

hypercalcemia s/s

A

shortening of QT interval, HTN and bradycardia

hyperpolaziation of cell membrane

refractory to stimulation

skeletal muscle weakness

easy fatiguability and perceived muscle weakness

constipation, ileus, nausea, vomiting

increased GI acid production -PUD

volume depletion and renal failure

mental status change

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20
Q

workup of hypercalcemia

A
  1. confirm w/repeat lab, check albumin

2. check intact PTH

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21
Q

treatment of asymptomatic hypercalcemia

A

<12 mg/dL

hydration

avoidance of drugs that worsen (thiazides, lithium)

avoidance of factors that worsen it (bedrest, depletion)

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22
Q

treatment of severe hypercalcemia

A

> 14 mg/dL

aggressive IV normal saline to expand volume and IV bisphosphonate (Zometa)

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23
Q

hypocalcemia (nerve)

A

reduces ionic difference across cell membranes therefore making cells hyper excitable

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24
Q

hypocalcemia neuromuscular cell symptoms

Study These Flashcards
A
  1. prolonged QT interval
  2. paresthesias
  3. seizures
  4. muscle spasms/tetany
25
hypocalcemia workup
begin with measurement of intact PTH magnesium, creatinine, phosphate, and vitamin D metabolites
26
hypocalcemia treatment
depends on the cause, severity, presence of symptoms and how rapidly hypocalcemia developed mild tx is asymptomatic, IV replacement is indicated to avoid severe arrhythmia
27
medications used in hypocalcemia
calcium gluconate (good!, gradually brings up Ca) calcium chloride (crap, given in central line)
28
primary hyperparathyroidism cause
mc of hypercalemia in healthy patients typically results from single autonomous parathyroid adenoma can be from multi-parathyroid gland hyperplasia parathyroid cancer (<1%)
29
primary hyperparathyroidism
causes mild elevations of serum calcium relatively asymptomatic
30
diagnosis of primary hyperparathyroidism
elevation in serum calcium and elevated intact PTH
31
if symptomatic primary hyperparathyroidism presents with
stones (kidney stones) bones (osteoporosis and bone pain) groans (constipation/abdominal pain) moans (psychiatric illness)
32
primary hyperparathyroidism labs
serum calcium will be high (>10.5) ionized serum calcium high (>5.4) serum iPTH high serum phosphate LOW
33
primary hyperparathyroidism treatment
asymptomatic: monitored with large fluid intake, pts typically note improvement in anxiety, phobias and mood significant symptoms- parathyroidectomy
34
following surgery for primary hyperparathyroidism
PTH levels rapidly fall and cause hypocalcemia must measure calcium levels and supplement Ca and Magnesium hyperthyroidism is common - give propranolol
35
hungry bones
following sx for 1 hyperparathyroidism PTH decreases and bone reabsorption falls rate of bone formation increases so hypocalcemia bc eats up all the calcium
36
hungry bones symptoms
parasthesia spasm may have seizures
37
secondary hyperparathyroidism
found in patients with chronic kidney disease or vitamin D deficiency kidney fails to normally excrete phosphorus and instead excretes calcium
38
pathophys of secondary hyperparathyroidism
hyperphosphatemia and hypocalcemia to stimulate PTH secretion elevated PTH coinages phosphate loss and mobilizes Ca2+ from bone but kidney can't do it failing kidney can't produce adequate vitamin D so intestinal Ca absorption parathyroid glands become hyper plastic renal osteodystrophy w/bone pain (can cause cardiovascular calcification)
39
labs of secondary hyperparathyroidism
serum calcium is LOW ionized calcium LOW serum PTH is HIGH serum phosphate is HIGH
40
treatment of secondary hyperparathyroidism
reduce dietary intake of phosphates (liquids, diary, protein, other) patient may be placed on phosphate binders normalization of vitamin D
41
phosphate binders MOA
bind to ingested phosphates, letting them pass out of GI tract without absorption
42
phosphate binders used
calcium acetate (PhosLo) Selevamer (renvela, renegel) fosrenol (Lanthanum)
43
what medication is used to normalize vitamin D levels
calciarlo (rocaltrol) doxercalciferol (Hectorol) Paricalcitol (Zemplar) stimulates to get more calcium from the gut
44
final tool in armamentarium to create secondary HPT caused by CKD
cinacalcet (sensipar) enhances sensitivity of parathryoid calcium receptor receptor is harder to stimulate
45
tertiary hyperparathyroidism pathophysiology
occurs in patients with long-standing CKD after renal transplant after kidney is transplanted the parathyroid is excessively stimulated and doesn't recognize serum calcium autonomously produce excessive parathyroid hormones
46
treatment of tertiary hyperparathyroidism
resistant to calcimimetic can deposit calcium in tissues treatment is by total or partial parathyroidectomy
47
ddx of all hyperparathyroidism
hypercalcemia of malignancy
48
hypercalcemia of malignancy
caused by tumor PTrH low/undetectable intact PTH
49
treatment options for hypercalcemia of malignancy
aggressive IV fluid w/saline bisphosphate (zometa)
50
hypoparathyroidism etiologies
1. iatrogenic 2. autoimmune destruction 3. hypomagnesemia rare, but can be caused by irradiation/infiltrative disease, genetic defect
51
hypomagnesemia is in which population
alcoholics
52
s/s of hypoparathyroidism
muscular (laryngospasm and bronchospasm) neurologic GI psychiatric chvostek sign trousseau sign
53
chovstek sign
trapping face causes face to twitch
54
trousseau sign
BP causes spasm of hand
55
lab abnormalities of hypoparathyroidism
Low PTH Hypocalcemia hypomagnesemia hyperphosphatemia exclude vitamin D deficiency
56
hypoparathyroidism treatment
IV calcium gluconate initially high oral calcium intake and supplements vitamin D to maintain thiazide diuretics (block excretion in urine) recombinant PTH (BBW - osteosarcoma)
57
pseudohypoparathyroidism
tissue insensitivity to PTH (NO underlying disease) results in hyperphosphatemia and hypocalcemia elevation in PTH levels to cause bone disease
58
pseudohypoparathyroidism treatment
normalizing serum calcium levels, prevent renal excretion of calcium and low PTH

FA17 Endocrine (10 decks)

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