What is the result of using PTH during surgery in the cause of parathyroid carcinoma
Does not go down during or after surgery
In the case of a solitary parathyroid adenoma, what is the effect on the other parathyroid glands
Usually shrunken, because the increased PTH production from the adenoma will cause a feedback and stop production from the other glands
What is the likely diagnosis with:
- Low calcium
- High PTH
-Secondary hyperparathyroidism
What is the pathogenesis of pseudohypoparathyroidism
-Receptors are resistant to PTH, so low levels of calcium even in the presence of high levels of PTH
Where are the parathyroid glands located
4 spots on the back of the thyroid
What are the histological findings in the cause of parathyroid hyperplasia
-Lack of adipocytes without a normal rim of parathyroid tissue
What is the usual histological finding in the cause of a parathyroid adenoma
Abnormal tissue right directly next to normal tissue
Abnormal tissue: will have the secretory Chief cells with a follicular architecture, absence of adipose cells
Normal: Will contain chief cells, oxyphil cells, and Adipocytes
What are the bodily responses to PTH release from the parathyroid glands
- Calcium release from bone
- Vitamin D production in the kidney
- phosphate excretion form the kidney
- Calcium absorption in the gut
What are the clinal presentations of a patient with Digeorge syndome
- Lack of adaptive immunity (no thymus)
- Cardiac abnormalities
- Hypocalcemia (no parathyroids)
What is the major cause of primary hyperparathyroidism
Adenomas (85-95%)
What is the likely diagnosis with:
- Low calcium
- Low PTH
Hypoparathyroidism
What is the scan done to look for a parathyroid adenoma
Technetium scan of the parathyroid gland, where there will be an increased uptake if there is an adenoma
What is the telltale sign used to help differentiate parathyroid carcinoma
Metastasis***
- Also invasion into adjacent tissues
- Vascular invasion
What are the parathyroid tumors seen with mutations in MEN 1
Parathyroid adenomas
What is the meaning of the primary hyperparathyroidism saying renal stone
Nephrolithiasis
What is the meaning of the primary hyperparathyroidism saying psychic moans
- Depression
- weakness/fatigue
- Seuzures
What are the causes of parathyroid hyperplasia
- MEN syndromes can be present
- Secondary hyperplasia is most common *
Pathogensis of sarcoidosis causing hypercalcemia
Increases vitamin d producing, resulting in calcium absorption from the intestines
What are the potential abnormal causes of raised PTH
- Hyperparathyroidism (most likely primary adenoma)
- Familial hypocalciuric hypercalcemia (hyper sensitive calcium sensing receptors)
What are the signs for hypocalcemia
- Muscle cramps and spasms (tetany)
- Trousseau sign (blood pressure cuff induces hand movements)
- Chvostek sign (tapping trigeminal nerve induces a twitch)
What are the causes of secondary hyperparathyroidism
- Renal failure (cant convert to Vit D)
- Vitamin D deficiency
- Pseudohypoparathyroidsm
What are the general findings in osteitis fibrosis cystica
- Starts as a cystic brown tumor***
- Osteoclasts bone destruction
- Small Fractures
- Hemorrhae and reactive tissue
What are the congenital conditions commonly leading to hypoparathyroidism
- Digeorge syndrome
- CASR germline mutations
- Familial isolated hypoparathyroidism
What is the likely diagnosis with:
- High Calcium
- Low PTH
- Humoral hypercalcemia of malignancy
- other PTH independent cause
