Hyperparathyroid Disease Quiz

Questions and Answers

What is the primary characteristic of Hyperparathyroid disease?

Excessive secretion of parathyroid hormone from one parathyroid gland (correct)

Excessive secretion of parathyroid hormone from multiple parathyroid glands

Normal secretion of parathyroid hormone from all parathyroid glands

Deficient secretion of parathyroid hormone from all parathyroid glands

What is the most common cause of Primary Hyperparathyroid disease?

Vasopressin receptor damage secondary to hyperkalemia

Chronic disease state leading to parathyroid cell hyperplasia

Secretion of PTH from a tumor in one of the parathyroid glands (correct)

Demineralization of bone

What is a complication of elevated PTH levels?

Demineralization of muscle

Pathologic fractures (correct)

Decreased excretion of calcium and phosphate by the kidneys

Hypocalcemia

What is the effect of excessive PTH concentrations on bone?

Demineralization and increased fragility Signup and view all the answers

Which age group is Primary Hyperparathyroid disease more frequent in?

Persons older than 40 years of age Signup and view all the answers

What is the incidence of new cases of Hyperparathyroid disease annually?

0.03% Signup and view all the answers

Which of the following is NOT a mechanism by which PTH increases serum calcium concentrations?

Inhibition of vitamin D synthesis Signup and view all the answers

What is a potential underlying cause of Secondary Hyperparathyroid disease?

Chronic renal failure Signup and view all the answers

What is the effect of PTH on the kidney?

Increased calcium reabsorption Signup and view all the answers

What is a laboratory finding that may indicate Secondary Hyperparathyroid disease secondary to Lung Cancer?

Decreased PTH level and Increased Calcium level Signup and view all the answers

What is the consequence of excessive circulating PTH and calcium on urine pH?

Abnormally alkaline urine Signup and view all the answers

What is the role of vitamin D in PTH-mediated calcium absorption?

Stimulates calcium absorption Signup and view all the answers

What is the prevalence of Hyperparathyroid disease in children?

Rare Signup and view all the answers

What is the consequence of excessive PTH and calcium on renal stone formation?

Increased risk of calcium-containing renal stones Signup and view all the answers

What is the effect of PTH on osteoclast activity?

Stimulates osteoclast activity Signup and view all the answers

What is the net effect of PTH on serum calcium concentrations?

Increase in serum calcium concentrations Signup and view all the answers

What is the effect of hypercalcemia on the gastrointestinal tract in HPTH disease?

Decreases peristalsis leading to constipation Signup and view all the answers

Which of the following is a characteristic of primary HPTH disease?

Serum phosphate is typically low Signup and view all the answers

What is the relationship between the size of a parathyroid adenoma and the serum PTH concentration?

The size of the parathyroid adenoma is directly related to the serum PTH concentration Signup and view all the answers

Which of the following is NOT a characteristic of secondary HPTH disease?

Urinary calcium and phosphate levels are often elevated Signup and view all the answers

What is the purpose of imaging tests in HPTH disease?

To localize a parathyroid tumor Signup and view all the answers

What is the clinical hallmark of primary HPTH disease?

Hypercalcemia Signup and view all the answers

Which of the following tests is used to diagnose HPTH disease?

Immunoradiometric assay Signup and view all the answers

What is scintigraphy used for in diagnosing diseases?

To record the distribution of radioactivity in a particular tissue Signup and view all the answers

What is the recommended treatment for asymptomatic HPTH disease with high serum calcium levels?

Surgical removal of the parathyroid glands Signup and view all the answers

What is the goal of subtotal parathyroidectomy in treating parathyroid hyperplasia?

To remove three and one-half parathyroid glands Signup and view all the answers

Why are patients with HPTH disease advised to avoid thiazide diuretics?

Because they increase serum calcium levels Signup and view all the answers

What is the treatment for parathyroid carcinomas?

Surgical removal of the tumor followed by radiation therapy Signup and view all the answers

Why is calcium carbonate given orally after surgery?

To reduce the probability of developing hypocalcemia Signup and view all the answers

What is the cause of paresthesias and tetany after surgery?

Hypocalcemia Signup and view all the answers

What is the treatment for symptomatic hypocalcemia?

Larger doses of calcium and occasionally calcitriol Signup and view all the answers

What is the main purpose of administering propranolol in patients with hyperparathyroid disease?

To prevent adverse cardiac effects associated with high circulating levels of thyroid hormones Signup and view all the answers

What is the treatment of choice for severe hypercalcemia associated with hyperparathyroid disease?

Intravenous saline hydration Signup and view all the answers

What is the mechanism of action of bisphosphonates in treating hypercalcemia?

Inhibiting bone resorption Signup and view all the answers

Why is vitamin D replacement beneficial in patients with hyperparathyroid disease?

It alleviates symptoms of vitamin D deficiency Signup and view all the answers

What is the effect of cinacalcet hydrochloride on parathyroid hormone secretion?

It decreases PTH secretion Signup and view all the answers

What is a potential complication of hypercalcemia associated with hyperparathyroid disease?

Pancreatitis Signup and view all the answers

What is the goal of treatment for bone disease associated with secondary hyperparathyroidism in renal failure patients?

To prevent hyperphosphatemia Signup and view all the answers

What is the route of administration of bisphosphonates in treating hypercalcemia associated with hyperparathyroid disease?

Intravenous Signup and view all the answers

Study Notes

Hyperparathyroid Disease (HPTH)

Characterized by excessive secretion of parathyroid hormone (PTH) from one or more parathyroid glands, leading to hypercalcemia, hypophosphatemia, and increased excretion of calcium and phosphate by the kidneys.

Etiologies

Primary HPTH: caused by a tumor in one of the parathyroid glands, leading to excessive PTH secretion.
Secondary HPTH: caused by chronic disease states, such as chronic renal failure, leading to decreased serum calcium levels and parathyroid cell hyperplasia.

Prevalence

Primary HPTH: incidence of 0.1-0.2%, more frequent in persons older than 40 years, and 2-3 times more common in women than men.
Secondary HPTH: rare in children, with an overall incidence of new cases approximately 0.03% annually.

Pathophysiology

PTH stimulates osteoclasts, leading to excessive bone resorption and demineralization.
PTH increases calcium reabsorption in the kidneys.
PTH stimulates vitamin D synthesis, leading to increased gastrointestinal calcium absorption.

Clinical Manifestations

Hypercalcemia: can lead to abdominal pain, peptic ulcer disease, constipation, and neuro psychiatric illnesses.
Muscular weakness and muscle pain (myalgia) are linked to degenerative changes in muscles and nerves.
Hypercalcemia can cause susceptibility to developing calcium-containing kidney stones.

Diagnosis

Characterized by a significant elevation in serum PTH concentration.
Immunoradiometric assay (IRMA) is a specific and sensitive test for PTH.
Hypercalcemia is often present, with urinary calcium and phosphate levels elevated, and serum phosphate typically low.
Bone x-ray changes may be present, but are not required for a definitive diagnosis.

Treatment

Surgical removal of parathyroid glands (parathyroidectomy) is recommended for symptomatic HPTH disease.
Non-pharmacologic and pharmacologic treatments may also be applicable.
Patients with mild, asymptomatic disease should keep active, avoid immobilization, and drink plenty of fluids.

Complications and Prognosis

Serious complications include renal failure, pathologic fractures, and hypercalcemia-induced pancreatitis.
Prognosis is generally good with treatment, but severe complications can increase mortality rates.

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Description

Test your knowledge of hyperparathyroid disease, an endocrine disorder characterized by excessive secretion of parathyroid hormone, leading to hypercalcemia and other symptoms.