Endocrine Disorders: Parathyroid Glands

Study Notes

Parathyroid glands are small endocrine glands located in the neck, typically four in number, on the back of the thyroid gland
They produce parathyroid hormone (PTH)
PTH plays a crucial role in regulating blood calcium levels (9-11 mg/100 ml) and calcium within bones.

Increases calcium absorption from the gastrointestinal tract (GIT)
Increases calcium reabsorption from the kidneys
Stimulates osteoclastic activity, releasing calcium from bones
Increases phosphate excretion from the kidneys
Increases the synthesis of vitamin D (1,25-dihydroxycholecalciferol), aiding calcium absorption from the GIT

General Manifestations: Occur when serum calcium levels fall below 7 mg/100 ml. Includes nausea, vomiting, paresthesia (numbness and tingling), muscle cramps, irritability, and tetany.
Trousseau's sign: Carpopedal spasm brought about by reduced blood flow to the hand.
Chvostek's sign: Twitching of facial muscles when the facial nerve is tapped
Oral Manifestations: Enamel hypoplasia, abnormal dentin formation, delayed tooth eruption, wide pulp chambers, and short roots

Arrhythmia and heart block may result from low calcium levels.
Increased risk of caries due to hypoplastic teeth.
Frequent oral care is crucial in patients with hypoparathyroidism for hypoplastic teeth to prevent complications
Emergency treatment for tetany: Intravenous calcium lactate injection (10-30 ml of 10% solution)

Primary: Parathyroid gland enlargement (adenoma)
Secondary: Resulting from low calcium levels due to conditions like kidney failure, malabsorption, or prolonged dialysis
Tertiary: Parathyroid gland tissue becomes unresponsive to blood calcium levels, usually resulting from long standing secondary cases

General Manifestations: Affecting the bones, kidneys, and gastrointestinal tract.
Bone: Generalized osteoporosis, osteitis fibrosa cystica (bone replaced with fibrous tissue), giant cell lesions (brown tumors), bone pain, and pathological fractures
Kidney: Renal stones, hematuria, urinary tract infections, renal hypertension
Gastrointestinal tract: Anorexia, nausea, vomiting, peptic ulcers, and crampy pain
Oral: Bone abnormalities (general manifestations), loss of lamina dura, teeth looseness and drifting, and giant cell granulomas (brown tumors)
Radiographic Features: Cortical bone resorption, rarefaction, loss of trabecular structure, ground glass appearance, and thinning or loss of cortical bone.

Oral manifestations can complicate dental management due to decreased bone density and other oral features.
Peptic ulcers, renal failure, and bone fragility can also be complications impacting dental treatment and subsequent recovery.