Parathyroid

Question 1

What is the function of the parathyroid gland?

Answer 1

controls calcium level in the body

Question 2

What are the inferior parathyroid glands derived from?

Answer 2

3rd branchial

Question 3

What is the blood supply & venous drainage of the parathyroid gland?

Answer 3

inferior thyroid artery

superior, middle, & posterior thyroid veins into internal jugular

Question 4

What is the function of PTH?

Answer 4

• conversion of calcidiol to calcitriol in renal tubular cells
• increase calcium absorption from intestine
• increase calcium resorption from the bone
• calcitriol feeds back to inhibit PTH secretion
• calcitonin secreted by parafollicular thyroid cells opposes it

Question 5

What are the causes of primary hyperparathyroidism?

Answer 5

• exposure to low-dose therapeutic ionizing radiation
• renal leak calcium
• decline in renal function by aging
• alteration in the sensitivity of gland for suppression by calcium
• lithium use

PRESENTS AS:
adenoma
hyperplasia
carcinoma

Question 6

what are the causes of secondary hyperparathyroidism?

Answer 6

• renal failure
• inadequate calcium intake
• inadequate calcium absorption (vitamin D deficiency)
• GI diseases causing malabsorption

Question 7

What are the causes of tertiary hyperparathyroidism?

Answer 7

further stage in the development of reactive hyperplasia where autonomy occurs as parathyroid gland doesnt respond to physiological stimuli

AFTER RENAL TRANSPLANT

Question 8

what is the presentation of a patient with hyperparathyroidism?

Answer 8

• asymptomatic
• kidney stones
• painful bones
• abdominal groans
• psychic moans
• fatigue overtones
• muscular weakness
• proximal neuropathy
• gout & pseudogout
• calcification at ectopic site
• increase death from cardiovascular disease

Question 9

how can hyperparathyroidism cause RENAL DISEASE?

Answer 9

• renal stone
• nephrocalcinosis
• chronic hypercalcemia leads to polyurea, polydipsiea, & nocturia
• hypertension

Question 10

how can hyperparathyroidism cause BONE DISEASE?

Answer 10

• osteopenia, osteoporosis, & osteitis fibrosa cystica
• brown or osteoclastic tumors & bone cysts
• severe bone disease results in severe pain, tenderness, & pathological fractures

Question 11

How can hyperparathyroidism cause GIT COMPLICATIONS?

Answer 11

• peptic ulcer disease
• pancreatitis if Ca > 12.5
• cholelithiasis

Question 12

What NEUROPSYCHIATRIC COMPLICATIONS does hyperparathyroidism cause?

Answer 12

• psychosis
• obtundation
• coma
• depression, anxiety, fatigue

Question 13

What could hyperparathyroidism be confused with?

Answer 13

• malignancy
• familial hypocalciuric hypercalcemia
• thiazide, lithium use

Question 14

What investigations should be done for a suspected case of hyperparathyroidism?

Answer 14

• calcium level
• PTH
• vitamin D
• magnesium balance
• acid base balance
• 24-h urine for calcium level

Question 15

What are the investigations used for diagnosis?

Answer 15

ULTRASOUND neck
CT scan of neck
MRI
99mTc-labeled sestamibi scan

Question 16

How should a patient with hyperparathyroidism be managed?

Answer 16

• resuscitation with 0.9% NS
• urine output >100ml/h
• diuresis with furosemide
• medications like
  
  • bisphosphonate
  • calcitonin
  • gallium nitrate
  • glucocorticoids
  • calcimimetics
• hemodialysis in life-threatening conditions
• surgery

Question 17

What are the indications for surgery in hyperparathyroidism?

Answer 17

• symptomatic hypercalcemia

- adenoma in primary HPT

Question 18

What are the complications of hyperparathyroidism surgery?

Answer 18

• transient or permanent vocal cord paralysis
• hypoparathyroidism
• hypocalcemia

hypocalcemia & vocal cord paralysis are considered permanent if more than 6 months

Question 19

What is the cause of hypoparathyroidism and how does it present?

Answer 19

COMPLICATION OF SURGERY

• tingling & numbness in face & toes
• carp pedal spasm
• Chvostek’s sign
• Trousseau’s sign

Question 20

What are the signs & symptoms of hypocalcemia?

Answer 20

CATS

• convulsions
• arrhythmias
• tetany
• stridor & spasms

Question 21

how should hypoparathyroidism be treated?

Answer 21

if patient is symptomatic: IV calcium 1g of calcium gluconate in 50mL of normal saline over 10-20mins

• oral calcitriol
• oral calcium
• correction of magnesium