Pathology of the Parathyroid Flashcards Preview

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Flashcards in Pathology of the Parathyroid Deck (36):
1

normal weight of parathyroid

25-50mg each

there are 4 of them

2

color of parathyroid

yellowish

has fat

more fat with age

3

cells of parathyroid

chief cells
oxyphil cells - more red - more mito

4

function of PTH

increase renal tubular reabsorption of calcium

increase conversion of vit D

urinary phosphate excretion

GI calcium absorption

5

primary hyperparathyroidism

adenoma or hyperplasia of parathyroid tissue

6

secondary hyperparathyroidism

chronic renal failure

compensatory hypersecretion of PTH in response to prolonged hypocalcemia

7

tertiary hyperparathyroidism

renal transplant

persistant hypersecretion of PTH even after cause of prolonged hypocalcemia is corrected

8

most common cause of primary hyperparathyroidism

adenoma - 85%

primary hyperplasia - diffuse or nodular 5-10%

parathyroid carcinoma 1%

9

52yo F elevated Ca on medical profile

sestamibi scan shows hot nodule

parathyroid adenoma

10

calcitonin scan

sestamibi
-technetium scan

11

primary hyperplasia vs. adenoma

adenoma - glands outside adenoma are shrunken - feedback inhibiion

12

most common identification of primary hyperparathyroidism

incidental on serum electrolyte panel - see hypercalcemia

13

genetic parathyroid adenomas

MEN 1 - MEN1 mutation
MEN 2 - RET mutation

14

primary hyperparathyroidism physiologic changes

skeletal system - osteoporosis, brown tumors, osteitis fibrosa cystica

urinary tract - nephrolithiasis

15

skeletal changes hyperparathyroidism

osteoporosis - phalanges, vertebra, femur - cortical bone affected most

medullary bone - osteoclast tunnel - railroad track appearance - dissecting osteitis

16

railroad track appearance

of bones

hyperparathyroidism

dissecting osteitis

17

brown tumor

bone loss in hyperparathyroidism - microfractures - influx of macrophages and fibrous tissue

hemosiderin deposition

18

von recklinghausen disease of bone

osteitis fibrosa cystica

combo of increased osteoclast activity, peritrabecular fibrosis, cystic brown tumors

severe hyperparathyroidism**

19

urinary tract and hyperparathyroidism

urinary tract stone formation - nephrolithiasis

also calcification of renal interstitium and tubules

20

most common cause of asymptomatic hypercalcemia

primary hyperparathyroidism

21

most frequent cause of symptomatic hypercalcemia in adults

malignancy

multiple myeloma

secretion of PTH-rP
-PTH related peptide

22

high calcium and low PTH

high calcium of malignancy

multiple myeloma and others

23

primary hyperparathyroidism associations

painful bones
renal stones
abdominal groans
psychic moans

24

enlargement of all 4 parathyroid glands

secondary hyperparathyroidism
-hyperplasia

most commonly - with renal failure

25

patients with secondary hyperparathyroidism

dietary vit D supps
phosphate binders

26

tx tertiary hyperparathyroidism

minority of patients - becomes excessive hyperparathyroid

parathyroidectomy to control hyperparathyroidism

27

common cause of hypoparathyroidism

consequence of surgery

during thyroidectomy

28

autoimmune hypoparathyroid

mutations in AIRE

childhood onset of candidiasis
several years later hypoparathyroidism
adolescence adrenal insufficiency

29

auto-dom hypoparathyroidism

GOF in SACR gene

hypocalcemia and hypercalciuria

30

familial isolated hypoparathyroidism

FIH - rare

auto dom - mutation in PTH precursor peptide

auto rec - LOF function in GCM2 - essential for parathyroid development

31

congenital absence of parathyroid

with other malformations

thymic aplasia
cardiovascular defects

22q11 deletion syndrome

32

chvostek sign

tapping facial nerve - induce contraction of muscles of eye, mouth, nose

hypocalcemia**

33

trousseau sign

carpal spasms - with occlusion of forearm circulation

hypocalcemia

34

hypocalcemia

tetany - neuromuscular irritability

deceased serum calcium levels

35

clinical of hypoparathyroidism

mental status changes

intracranial manifestations - parkinsonian like movement disorders

ocular disease - lens and cataracts - calcification

cardiovascular manifestations - prolonged QT interval

dental abnormalities

36

pseudohypoparathyroidism

end organ resistance to PTH action

hypocalcemia, hyperphosphatemia, elevated circulating PTH

short stature, mental retardation, short 4th and 5th fingers