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Endocrine > Parathyroid gland > Flashcards

Parathyroid gland Flashcards

1
Q

when calcium is low in the blood, what does it bind to

A

Calcium sensitizing receptor on the parathyroid gland

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2
Q

when calcium binds to calcium sensitising receptor it causes what

A

release of PTH which causes increases calcium

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3
Q

Where is PTH absorbed

A

the gut

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4
Q

Where is PTH resorbed

A

bones

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5
Q

What is needed to promote Calcium absorption in the intestines

A

Vitamin D

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6
Q

what is vitamin D needed for

A

calcium absorption into intestines
bone resorption by increasing osteoclast number
to promote proper function of parathyroid gland

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7
Q

What are the symptoms of acute hypercalcaemia

A

thirst
dehydration
confusion
polyuria

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8
Q

what are the symptoms of chronic hypercalcaemia

A 
myopathy
osteopenia
fractures
depression
abdominal pain - pancreatitis, ulcers, renal stones
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9
Q

What is the rhyme to remember the complications of chronic hypercalcaemia

A

stones, groans, bones, psychic moans

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10
Q

What is the investigation for hypercalcaemia

A

albumin - if low, check PTH

if PTH normal/high, check urine Calcium (if increased then either primary/tertiary hyperparathyroidism

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11
Q

what is the most common cause of hypercalcaemia

A

primary hyperparathyroidism

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12
Q

what are other causes of hypercalcaemia

A 
malignancy 
vitamin D supplements 
thiazides
granulomatous diseases - sarcoidosis, TB
familial hypocalciuric hypercalcaemia
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13
Q

what would the biochemistry of granulomatous diseases causing hypercalcaemia look like

A

low PTH

high Ca

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14
Q

what would the biochemistry of familial hypocalciuric hypercalcaemia look like

A

normal/high PTH
low urine Ca
high serum Ca

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15
Q

What does the biochemistry of primary hyperparathyroidism look like

A

increased serum PTH
increased serum Ca
increased urine Ca

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16
Q

what does the biochemistry of malignancy causing hypercalcaemia look like

A

high serum Ca

increased Alk phos

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17
Q

what other investigations would be helpful for suspected malignancy in hypercalcaemia

A

X-ray
CT
MRI
isotope bone scan

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18
Q

what is the acute treatment for hypercalcaemia

A

IV fluids 0.9% saline
consider loop diuretics (decrease Ca reabsorption)
bisphosphonates (single dose will decrease Ca over 2-3 days)

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19
Q

What is the treatment for primary hyperparathyroidism

A

surgery/nothing (drugs don’t work)

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20
Q

What are the indications for surgery in primary hyperparathyroidism

A

if organ damage
very high calcium (>2.85)
under 50yrs
eGFR <60l/min

21
Q

primary hyperparathyroidism can be described as

A

overactivity of the parathyroid

22
Q

what is the most common cause of primary hyperparathyroidism

A

adenoma

23
Q

secondary hyperparathyroidism can be described as

A

physiological response to low calcium

24
Q

what are the causes of secondary hyperparathyroidism

A

malnutrition (vitamin D deficiency)

chronic kidney disease

25
Q

what does the biochem of secondary hyperparathyroidism look like

A

Ca decreased

PTH increased

26
Q

What can tertiary hyperparathyroidism look like

A

occurs in a patient with a parathyroid after its been secondary for years
when it tries to go back to normal, it’s already secreting too much PTH

27
Q

What does the biochem of tertiary hyperparathyroidism look like

A

increased calcium

increased PTH

28
Q

What is the inheritance of familial hypocalciuric hypercalcaemia

A

autosomal dominant

29
Q

What is the mutation in hypocalciuric hypercalcaemia

A

deactivating mutation in calcium sensing receptor

30
Q

Hypocalciuric hypercalcaemia is usually

A

benign/asymptomatic

31
Q

What is the investigation for familial hypocalciuric hypercalcaemia

A

genetic screening

32
Q

What are the symptoms of hypocalcaemia

A 
paraesthesia - fingers, toes, peri-oral
muscle cramps, tetany
muscle weakness
fatigue 
bronchospasm 
fits 
Chovstek's sign 
Trousseau sign
33
Q

What is chovstek’s sign in hypocalcaemia

A

face will twitch when tapping over the facial nerve

34
Q

what is trouseau’s sign in hypocalcaemia

A

carpopedal spasm

35
Q

what will be seen on ECG of someone with hypocalcaemia

A

QT prolongation

36
Q

what are the causes of hypocalcaemia

A

hypoparathyroidism
Vit D deficiency
chronic renal failure

37
Q

What is the treatment for acute hypocalcaemia

A

IV calcium gluconate - 10ml 10% over 10min (dissolved in 50ml saline/dextrose)

38
Q

What are the causes of hypoparathyroidism

A 
DiGeorge syndrome
Destruction - surgery, radiotherapy, malignancy 
autoimmune
hypomagnesaemia 
idiopathic
39
Q

why does DiGeorge syndrome cause hypoparathyroidism

A

they have no parathyroid glands

40
Q

What is the long term management of hypoparathyroidism

A

Calcium supplements

vitamin D supplements - 1alpha calcidol (tablet), cholecalciferol (injection)

41
Q

Calcium release from cells is dependent on magnesium. If magnesium is decreased, what happens to intracellular Calcium

A

increases

42
Q

If intracellular calcium increases, what happens to PTH

A

decreases

43
Q

What is the treatment for hypomagnesaemia

A

magnesium and calcium replacement

44
Q

what are the causes of hypomagnesaemia

A 
alcohol
thiazides
PPIs
GI illness
pancreatitis 
malabsorption
45
Q

Pseudohypoparathyroidism is caused by a genetic defect in what

A

GNAS1

46
Q

What does the biochem look like in pseudohypoparathyroidism

A 
decreased Calcium 
increased PTH (due to PTH resistance)
47
Q

What are the complications of pseudohypoparathyroidism

A 
bone abnormalities (McCune Albright) 
obesity
subcutaneous calcification 
learning disability
brachdactylyl (loss of 4th metacarpal)
48
Q

Chronic renal disease can cause vitamin D deficiency which leads to secondary hyperparathyroidism. what might be seen on investigation

A

increased 25-OH vitamin D

Endocrine (4 decks)

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