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Endocrine > Pathophysiology: Ca and PTH > Flashcards

Pathophysiology: Ca and PTH Flashcards

1
Q

What are the fast PTH responses? Slow?

A

Fast: bone and renal resorption
Slow: Intestinal Vit D, renal effect takes time

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2
Q

What senses Ca in the Parathyroid?

A

CaSR

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3
Q

What are the top three causes of HyperPTH?

A

PT Adenoma
Familial HypocalURIA HypercalcEMIA
Lithium or HCTZ meds
<1% PT carcinoma

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4
Q

What are the PTH dependent causes of high Ca?

A

HyperPTH, Familial HH, Li/HCTZ

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5
Q

What are the PTH independent causes of high Ca?

A

Tumor
Granulomatous disease
Multiple myeloma

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6
Q

Waht is the treatment of acute high Ca?

A

Saline (to correct polyuria)

Furosemide (to draw off Ca)

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7
Q

What is the presentation of PT Adenoma? What do you to?

A

Stones: pain while peeing
Groans: constipation/GI pain
Bones: fractures?

Measure albumin, PTH

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8
Q

What do you do to differentiate FHH and PT adenoma?

A

24 hour urine:
PTadenoma: high Ca
FHH: low Ca

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9
Q

What is the defect in FHH?

A

CaSR, AD mutation

decreased Ca sensation removes negative feedback of PTH increasing Ca

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10
Q

What is typical 24 hr urine in FHH?

A

<50-100

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11
Q

What is 3* HyperPTH?

A

End stage renal disease, post kidney transplant causes Ca wasting in urine

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12
Q

What cancers make Ca higher?

A

Small cell lung
Breast
*Mets, cytokines, multiple myeloma

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13
Q

What do labs for cancer high Ca look like?

A

HIGH Ca, low PTH (PTHrelated peptide is made, NOT PTH!)

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14
Q

What causes increased Ca in granulomatous disease?

A

1a Hydroxylase–>increased VitD3

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15
Q

How do you tell difference between gland hyperplasia and adenoma?

A

Adenoma: one site
Hyperplasia: whole gland

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16
Q

What is 2* hyperPTH?

A

Renal disease: HIGH PTH! but it doesnt work…

low Ca, high PO4, low VitD3

17
Q

What are causes of low Ca?

A

Albrights hereditary osteodystrophy
MEN syndromes

*acute pancreatitis, transfusion, tumor lysis, rhabdomyolysis, sepsis, bisphosphonates, hungry bone syndrome

18
Q

DDx for low Ca?

A

PTH low? HypoPTH, Mg deficiency, PO4 excess

PTH high? Vit deficiency, renal failure, PTH/VitD resistance

19
Q

How does low Ca present?

A 
Agitation
Hyperreflexia
Convulsions
QT prolongation
Hyperextension
20
Q

Tx for acute low Ca?

A

Correct Mg

Calcium gluconate

21
Q

Tx for chronic low Ca?

A

Oral Ca
Vit D if PTH still present
HCTZ

22
Q

What is defect in PseudohypoPTH? What do they look like?

A

Gsa subunit mutation, cannot stimulate PTH via cAMP pathway

*Short stature, round face, “short 5th metacarpal”, obesity

23
Q

MEN definition?

A

Multiple Endocrine Neoplasia:

Multiple tumors, 1 patient

24
Q

When do MEN 1 patients get pancreatic cancer?

A

25-35, pituitary by 38, 1* HPT by 40

25
Q

MEN 1 includes?

A 
Defect in MENIN: TSG MEN1
Chromosome 11
"PPP"
Pancreas: hypoglycemia
Parathyroid: high Ca, stones
Pituitary: galactorea, weight gain, diarrhea
26
Q

Patient presents with polyuria, pain in peeing and lethargy, found passing out and says to have grown breasts and gained weight:

A

MEN1: PPP

27
Q

MEN 2a?

A 
RET : RTK oncogene
Chromosome 10
"TPP"
Thyroid: medulary
Pheochromocytoma
Parathyroid
28
Q

MEN 2b?

A 
RET/Cr.10-single AA!
TPMM
Thyroid: medulary
Pheochromocytoma
Marfan-looking
Mucosal Neuromas
29
Q

Especially tall patient has lump in throat and bumps on tongue?

A

MEN2b

30
Q

Large round patient has kidney stones and is bugging out eyes….

A

MEN2a (terrible presentation… sorry)

31
Q

What branchial pouch do top 2 parathyroids develop from?

A

4th

32
Q

What branchial pouch do bottom 2 parathyroids develop from?

A

3rd (with Thymus!)

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