parathyroidism

Question 1

classification of hyperparathyroidism

Answer 1

1. over production
2. compensatory mechanism due to chronic hypocalcemia
3. extopic production - due to long stand-ing cases of chronic hypocalemia that even if you correct it it will persists

Question 2

what tumour is associtaed with hyperparathyroidism

Answer 2

brown tumour due to increase in clasts

Question 3

signs/complications of hypercalcemia

Answer 3

osteoporosis 
stones 
keratopathy - corneal depostion CALLED BAND KERATOPATHY - slit lamp 
hypertension- diastolic 
/cardiac arrythmias
nephrogenic DI

mones groans stones and psychiatric

abdominal groans- gi constiaption N& v
Painful bones- pseudo gout
Psychiatric Moans – Effects on nervous system: lethargy, fatigue, memory loss, psychosis, depression

muscles: ache, biopsy will show atrophy of myofibrils esp type 2

Neuropathy can be established on electromyography.

heart - Brady
short qt interval

poyuria (if diabetes insipidus0

severe cases:
bone cysts- can see on x ray
marrow fibrosis
fractures due to osteopeoprois due to deminierlaization

‘salt and pepper’ due to extensive areas of demineralization
calcifications of soft tissue- very high and can go to skin causing prurtits
brown tumour -highly vascularised with cuts

Question 4

IS CKD associated with hypercalcemia or hyo

Answer 4

hypo

Question 5

pseudoparathyrodism and constellation

Answer 5

body fails to respond to the hormone pth so production is fine. divided into type 1a and typs 2b
normal/low ca but high PTH and high P

Question 6

Pseudopseduo

Answer 6

Patient has the phenotypic appearance of pseudo but has normal values

Question 7

all brights hereditary osteodystrophy

Answer 7

falls under pseudoparathyrodism - short neck, bradydactyly round face

Question 8

function of PTH

Answer 8

increase calcium levels via osteoclasts and kidneys and effect on the gut is INDIRECT via 1, 25 oH

Question 9

ROLE OF 1,25(ОН)2D3

Answer 9

The principle physiologic role of 1,25(ОН)2D3 is to increase plasma levels of Ca and P and thus to maintain conditions favorable for bone mineralization.

now here we are talking about the GUT!!!

Question 10

MECHANIS FOR INCREASING CALCIUM VIA PTH

Answer 10

⇓ Са → ⇑ secretion of PTH and ⇓ secretion of calcitonin;
This leads to ⇑ bone resorption, ⇓ renal excretion and ⇑ intestinal absorption of Са (via enhanced 1,25(ОН)2D3 production);

Question 11

causes of primary hyperparathyroidism

Answer 11

1. an adenoma of 1 gland - majority (usually in the inferior segment)
   2 .hyperplasia of the glands
   3.carcinoma
2. MEN TYPE 1

Question 12

effect of calcium on kidneys

Answer 12

tubular+ peritubualar changes mainly distal+henle - calcifications

partial nephrogenic DI

stones - due to hypercalcuria and hyperohospaturia

nephrolithiasis and in 2% - NEPHROCALCINOSIS CAN OCCUR

Question 13

brown tumour

Answer 13

The brown tumor is a bone lesion that arises in settings of excess osteoclast activity, such as hyperparathyroidism. They are a form of osteitis fibrosa cystica. It is not a neoplasm, but rather simply a mass. It most commonly affects the maxilla and mandible, though any bone may be affected.

Question 14

GI features

Answer 14

sialoliathiasis 
gastric stimulation increased so peptic ulcer increase
NASEUA, VOMITING , CONSTIPATION 
CHOLELIATHIASIS more common 
chronic pancreatitis?

Question 15

ectopic hyperparathyroidism

Answer 15

also called psudohyperthyrodims associated with tumours - lung ca, breast ca

Question 16

Acute hyperparathyroidism:

Answer 16

Due to hemorrhage or necrosis of the parathyroid adenoma. but can also be seen in non neoplasm states like dehydration and diuretic overuse

A large quantity of PTH enters the circulation and leads to rapid excessive increase of calcium level (above 3.5-4 mmol/l).

Question 17

normal calcium levels

Answer 17

2.12-2.62 mol

Question 18

signs of acute

Answer 18

strongly ensembles vitamin d toxicity

first VOMITTING + polyuria followed by dehrdayion, signs of AKI- oligoruia, acidosis

Question 19

diagnosis of primary hyperthyroidism

Answer 19

urinary camp

and serves for differentiation between hyperparathyroidism and pseudohyperparathyroidism

1-25(ОН)2D level is increased, because PTH stimulates 1α-hydroxylase in the kidneys

Hyperchloremic acidosis is typical for the primary hyperparathyroidism, while other hypercalcemic conditions are characterized with metabolic alkalosis with lower chloride concentration.

Question 20

tx of acute hypercalmceia

Answer 20

1. calcitonin
2. biphosphanates
3. dialysis
4. CS - increase excretion
5. diuertics

Question 21

cincalcet

Answer 21

used to treat high levels of PTH

esp in patients with chronic renal failure who are on dialysis

also fpr parathyoid cancee