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endocrine > Parathyroid Disorders > Flashcards

Parathyroid Disorders Flashcards

1
Q

What is hypocalcaemia

A

Low calcium levels in the blood serum

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2
Q

Causes of hypocalcaemia

A

Chronic kidney disease
(Pseudo)hypoparathyroidism
Autoimmune
Hypomagnesaemia

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3
Q

Symptoms of hypocalcaemia

A

Paraesthesia of the fingers and toes
Muscle cramps and weakness
Fatigue
Fits
Bronchospasm or laryngospasm

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4
Q

Clinical signs of hypocalcaemia

A

Chovesteks sign
Trousseau sign
QT prolongation on ECG

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5
Q

What is chovesteks sign

A

Gentle tapping over the facial nerve causes twitching of the ipsilateral facial muscles

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6
Q

What is trousseau sign

A

Inflation of the BP cuff above systolic pressure for 3 mins induces tetanic spasm of the fingers and wrist

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7
Q

Investigation of hypocalcaemia

A

Low serum calcium

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8
Q

Management of acute severe hypocalcaemia

A

IV calcium gluconate
Calcium infusion

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9
Q

Long term management of hypocalcaemia

A

Supplement
Vitamin D

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10
Q

What is hypomagnesemia

A

Low magnesium levels in the blood serum

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11
Q

Causes of hypomagnesemia

A

Alcohol, drugs, GI illness with diarrhoea, pancreatitis, malabsorption

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12
Q

Name some drugs which can cause hypomagnesemia

A

Thiazide, PPIs

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13
Q

Symptoms of hypomagnesemia

A

Anorexia
N+V
muscle weakness, lethargy
Fits

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14
Q

Clinical signs of hypomagnesemia

A

Cardiac arrhythmia
Positive chovestek sign + trousseau sign indicate secondary hypocalcaemia

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15
Q

Investigations for hypomagnesemia

A

Low serum magnesium
*measure other electrolytes: K+, Ca2+

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16
Q

Management of hypomagnesemia

A

Magnesium supplementation
+ calcium supplements if needed

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17
Q

What is the main complication of hypomagnesemia

A

Secondary hypocalcaemia

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18
Q

What is hypoparathyroidism

A

Condition where the parathyroid glands produce too little parathyroid hormone

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19
Q

Causes of hypoparathyroidism

A

DiGeorge syndrome
Destruction of gland
Autoimmune: Addisons, pernicious anaemia
Hypomagnesemia

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20
Q

What is the result of too little parathyroid hormone being produced

A

Causes blood calcium levels to fall and blood phosphorus levels to rise

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21
Q

Which cells produce parathyroid hormone

A

Chief cells

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22
Q

Clinical presentation of hypoparathyroidism

A

Paraesthesia in fingers, toes and lips
Twitching facial muscles
Tiredness, mood changes
Dry, rough cough
Coarse hair and fingernails that break easily

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23
Q

Biochemistry of hypoparathyroidism

A

Low PTH
low calcium
High phosphorus

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24
Q

Management of hypoparathyroidism

A

Calcium supplement + vit D

25
Q

What is pseudohypoparathyroidism

A

Condition associated primarily with resistance to PTH

26
Q

Genetic defect associated with pseudohypoparathyroidism

A

Dysfunction of Gs alpha subunit (GNAS1 gene)

27
Q

Pathophysiology of pseudohypoparathyroidism

A

End organ resistance to PTH due to mutation of Gsa protein which is coupled to the PTH receptor

28
Q

Clinical presentation of pseudohypoparathyroidism

A

Bone abnormalities
Obesity
Subcutaneous calcification
Learning disability
Brachydactyly

29
Q

What is brachydactyly

A

Shortened fingers and toes

30
Q

Blood results in pseudohypoparathyroidism

A

Low calcium
Elevated PTH due to resistance

31
Q

What is pseudo-pseudohypoparathyroidism

A

Patient has the features of pseudohypoparathyroidism but normal blood calcium and phosphate levels

32
Q

What is hyperparathyroidism

A

Overactivity if the parathyroid glands with high levels of PTH

33
Q

What causes primary hyperparathyroidism

A

Tumour of the parathyroid gland

34
Q

Management of primary hyperparathyroidism

A

Removal of the tumour

35
Q

What causes secondary hyperparathyroidism

A

Low vitamin D or chronic kidney disease

36
Q

What causes tertiary hyperparathyroidism

A

Occurs when secondary continues for a long time leading to hyperplasia of the glands

37
Q

Blood results in primary hyperparathyroidism

A

High PTH
high calcium

38
Q

Bloods in secondary hyperparathyroidism

A

High PTH
low or normal calcium

39
Q

Bloods in tertiary hyperparathyroidism

A

High PTH
High calcium

40
Q

Roles of PTH (4)

A

Activates osteoclasts
Increases reabsorption of calcium by renal tubules
Increases urinary phosphate excretion
Increased synthesis of active forms of vit D

41
Q

How is PTH production usually regulated

A

It’s functions increase serum calcium which inhibits PTH secretion

42
Q

What is a complication of unchecked hyperparathyroidism

A

Fibrosa cystica

43
Q

Clinical features of fibrosa cystica

A

Osteoporosis
Brown tumours
Osteitis

44
Q

How can brown tumours present on investigation

A

Lytic lesion on x-ray

45
Q

Management of secondary hyperparathyroidism

A

Correcting vitamin D deficiency
Renal transplant to treat failure

46
Q

Management of tertiary hyperparathyroidism

A

Surgical removal of the part of the parathyroid tissue

47
Q

Indications for parathyroidectomy

A

End organ damage
Very high calcium
Under the age of 50

48
Q

What is hypercalcaemia

A

High calcium levels in the blood serum

49
Q

Name some causes of hypercalcaemia

A

Primary or tertiary hyperparathyroidism
Malignancy
Genetic syndromes
Drugs
Granulomatous disease

50
Q

Name some genetic syndromes which can cause hypercalcaemia

A

MEN1 + 2
Familial isolated hyperparathyroidism
Familial hypocalciuric hypercalcaemia

51
Q

What is Familial hypocalciuric hypercalcaemia

A

Autosomal dominant deactivating mutation in the calcium sensing receptor which decreases the sensitivity

52
Q

Name some drugs which can cause hypercalcaemia

A

Vit D, thiazide

53
Q

Clinical presentation of hypercalcaemia

A

Stones, bones, groans and psychiatric moans

54
Q

symptoms of acute hypercalcaemia

A

Thirst, dehydration, polyuria
Confusion

55
Q

What is polyuria

A

Excessive production of urine

56
Q

Symptoms of chronic hypercalcaemia

A

Myopathy
Fractures
Osteopenia
Depression
Hypertension

57
Q

Biochemistry of hypercalcaemia

A

Raised calcium
Serum ALP raised in malignancy
Serum PTH raised in hyperparathyroidism

58
Q

Investigations of Familial hypocalciuric hypercalcaemia

A

Bloods: mild hypercalcaemia, reduced urine calcium excretion, PTH may be marginally elevated
Genetic screen

59
Q

Management of acute severe hypercalcaemia

A

Rehydrate with 0.9% saline
Consider loop diuretics once rehydrated
Bisphosphonates

endocrine (15 decks)

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