PARATHYROID DISEASE- Hyper, Hypo Flashcards
(19 cards)
parathyroid hormone function
to inc plasma calcium
- PTH act on kidneys to turn vit D into calcitriol
calcitriol function
- bone
- kidneys
- intestines
bone- mobilizes calcium out of bones
kidneys- enhances renal reabsorp of calcium
intestines- inc intestinal absorp of calcium
parathyroid gland
diet+enviro intake of vit D–>liver–> 25, hydroxy D3–> kidney–> calcitriol (1,25 dihydroxycholecalciferol)–> bone, distal nephron, intestine —> inc plasma calcium
also
dec plasma calcium —> trigger PTH release—> inc release of calcitriol from kidney
hyperparathyroidism causes primary v. secondary
primary
- excess PTH by parathyroid (result in excess calcium, high PTH)
secondary
- condition causes dec calcium –> stim extra PTH release to normalize levels (low/nl calcium but high PTH)
hyperparathyroidism is the MCC of ?
hypercalcemia (only primary)
primary hyperparathyroidism causes
- MCC adenoma (benign tumor)
- hyperplasia
- carcinoma
- meds: lithium (chronic), HCTZ
primary hyperparathyroidism
- S/Sx
- other
ASx, but when Ca > 12
- Stones (kidney), bones (ache/pain), abd moans (constipated), psych groans (depressed, confused)
other Sx
- polydispsia, polyuria
- shortened QT interval, bradycardia
primary hyperparathyroidism
- bone complication
osteitis fibrosa cystica
- “brown tumors”
- bony areas replaced w fibrous tissue, inc risk pathologic fractures
secondary hyperparathyroidism causes
- MCC CKD (causes dec serum Ca, dec converwsion vit D to calcitriol)
- vit D deficiency
secondary hyperparathyroidism presentation
commonly ASx
if severe/long standing
- muscle pain
- bone pain
- fractures (extreme)
hyperparathyroidism Dx
- Primary v. Secondary
check serum PTH, Calcium, Phos
- primary: high serum PTH, high serum calcium, low serum phos
- secondary: high serum PTH, nl/low serum calcium, high serum phos (look for underlying cause)
best to check ionized calcium levels (no correction for albumin needed)
hyperparathyroidism management
- primary (surgical and non surgical)
surgical removal- definitive tx
- adenoma: remove
- hyperplasia: remove all 4 glands
- carcinoma: affected Ln + ipsilateral thyroid lobe removal
medical tx/before surgery: inc fluid + diuretic/ furosemide
no surgery: cinacalcet or alendronate
hyperparathyroidism management
- secondary
tx relative to underlying ds
- CKD: calcitriol + oral calcium, limit dietary phos
- vit D def: supplement w vit D
hypoparathyroidism
destruction of parathyroid glands or abnorm development of glands
- impaired PTH production or action
- results in hypocalcemia
hypoparathyroidism causes
- MCC
- MCC accidental removal during head/neck surgery
- non surgical less common (autoimmune gland destruction, low magnesium, radiation, congenital)
hypoparathyroidism presentation
- acute manifestations
acute manifestations
tetany
- mild: perioral numbness, paresthesia
- severe: carpo-pedal spasm laryngospasm
classic finding
- trousseau: carpal spasm after after inflating BP cuff above pts SBP for 3 mins
- chovsteks sign: tapping facial nerve causes facial muscle contraction
hypoparathyroidism presentation
- chronic manifestations
- dry, puffy, coarse skin
- coarse, brittle, sparse hair w patchy alopecia
- brittle nails, transverse grooves
- cataracts
- basal ganglia calcifications (parkinsons, dementia cause)
- skeletal abnorm
hypoparathyroidism dx
low serum calcium, high serum phos, low serum PTH
- check Mg—>dec Mg is a reversible cause
hypoparathyroidism
- tx (acute/post surgery v. chronic)
- tx goals
acute/post surgical: IV calcium gluconate + PO calcitriol
chronic: oral calcium + vit D
tx goals
- Calcium in low/nl range (8-8.5), relieve Sx, prevent iatrogenic kidney stone development
