how many para thyroid glands are there?
4 glands
what is the function of parathyroid hormone?
make PTH in response to the calcium level in blood
- increase osteoclast activity in bone to cause Ca to be released
- increased ca reabsorption in kidney
- increased activation of vit D in kidney (increase ca reabsorption from food in small intestine)
when there is too little Ca what happens?
the glands make more PTH which puts more Ca into the blood( increase reabsorption )
what are the causes of hypoparathyroidism ?
thyroidectomy (removal )
what will hypoparathyroidism lead to?
decrease in Ca and increase in serum phosphate
what are the symptoms of hypoparathyroidism?
- tetany
- decrease threshold for nerve and muscle excitation
- muscle spasm , hyperreflexia and laryngeal spasms
- respiratory paralysis
- paresthesias (finger tip burning sensation)
- prolonged QT interval
what are the physical assessment test to do to test for hypoparathyroidsm ?
- chvostek sign
- contraction of facial muscles after tapping of facial nerve - trousseau sign
- induction of carpal pedal spasm by inflation of BP calf machine
- adduction of thumb
- flexion of metacarpalangeal joints
- flexion of wrist
what are the treatment methods of hypoparathyrodism ?
injecting calcium or vit D directly into the blood stream
what are the primary causes of hyperparathyroidism?
tumor in the gland (increase PTH and increase serum Ca)
hyperplasia and adenoma
what are the secondary causes of hyperparathyroidism ?
low level of Ca (body have to increase pTh to increase serum Ca)
due to :
- renal failure
- intestinal malabsorption
- vitamin D insufficiency
what is the tertiary cause of hyperparathyroidism?
autonomous parathyroid hyperplasia after prolonged secondary hyper
what are the symptom of hyperparathyroidism?
- painful bones, soften and deform (osteitis fibrosa cystica)
- renal stones
- groans due to constipation, peptic ulcer, pancreatitis )
- lethargy, depression and confusion (affect and depress the nervous system)
what are the diagnostic test used to diagnose hyperparathyroidism?
- GOld standard test : PTH assaay
- serum calcium level
primary: high PTH, high calcium
secondary : high PTH , low or normal calcium
what are the treatment for hyperparathyrodism ?
primary: removal
secondary : pituitary surgery
