- Thyroid gland
- Parathyroid gland
- Regulates metabolism
- Regulates body’s calcium
Kidney contains the enzyme _ that converts
- 1 alpha hydroxylase
- 25 hyrdoxy Vitamin D to 1,25 dihydroxy Vitamin D
Vitamin D
- In the intestine, helps absorb Ca2+
- Must first be activated PTH
Hypoparathyroidism: Hypocalcemia
Causes:
-Surgical removal of glands during thyroidectomy, DiGeorge Syndrome, and hereditary autoimmunity syndrome. -Hypoparathyroidism is most common cause of hypocalcemia. Others covered in other systems. Hypoparathyroid/Hypocalcemia Signs & Symptoms: • Neuropsych: Seizures, dementia, anxiety, depression, extrapyramidal symptoms (parkinsonism most common), papilledema • Neuromuscular: Paresthesia around mouth and fingers/toes, muscle stiffness, myalgia and spasms • CV: CHF, hypotension, prolongation of QT interval • Autonomic: Biliary colic, bronchospasm, diaphoresis • Other: Cataracts, dry coarse skin, hyperpigmentation, eczema, steatorrhea
- Chvostek Sign
twitching of the facial muscles in response to tapping over the area of the facial nerve
In response to hypocalcemia
- Trousseau’s Sign
- This increases the irritability of the nerves, and a flexion of the wrist and metacarpal phalangeal joints can be observed with extension of the interphalangeal joints and adduction of the thumb (carpal spasm).
- Hyperparathyroidism: Hypercalcemia
- Causes
- Symptoms
- Causes
- Primary hyperparathyroidism (high PTH)
- Adenomas (associated with MEN 1)
- Gland enlargement
- Carcinoma
- Secondary hyperparathyroidism (low calcium causes high PTH)
- Renal failure
- VItamin D def
- Malabsorption
- Symptoms
- Lethargy, weakness, confusion, coma
- Polyuria, dehydration, nocturia, renal stones, renal failure
- Constipation, nausea, anorexia, gastric ulcer, pancreatitis
- Syncope from arrhythmias
Mnemonic to remember Hyperparathyroidism: Hypercalcemia
- Stones (renal or biliary)
- Bones (bone pain)
- Groans (abdominal pain, nausea, vomiting)
- Thrones (polyuria) resulting in dehydration
- Psychiatric overtones (Depression, anxiety, cognitive dysfunction, insomnia, coma)
- Workup for hyperparathyroidism: hypercalcemia and treatment
- Workup
- Serum Ca2+, albumin, Mg2+ and PTH
- (If low Albumin, Ca2+ will need to be adjusted)
- 24hr urine calcium
- Workup for malignancy, genetic disorder,diet, etc
- Management
- Monitor dietary and medication high in Ca2+ and Vitamin D
- Keep well hydrated
- Maintain physical activity
- Surgery
