Podcast
Questions and Answers
Which condition is characterized by 'Stones, Bones, Abdominal Groans, & Psychiatric Overtones'?
Which condition is characterized by 'Stones, Bones, Abdominal Groans, & Psychiatric Overtones'?
- Hypercalcemia (correct)
- Hyperparathyroidism
- Hypocalcemia
- Nephrolithiasis
What is a common presentation of hypocalcemia?
What is a common presentation of hypocalcemia?
- Parathyroid adenoma
- Heart failure
- Increased Muscle Spasticity (correct)
- Nephrolithiasis
What is the most common cause of hypercalcemia?
What is the most common cause of hypercalcemia?
- Carcinoma
- Vitamin D deficiency
- Gland hyperplasia
- Parathyroid adenoma (correct)
Which lab result is expected in primary hyperparathyroidism?
Which lab result is expected in primary hyperparathyroidism?
What is the treatment of choice for primary hyperparathyroidism?
What is the treatment of choice for primary hyperparathyroidism?
Which condition presents with symptoms like 'Akathisia' and 'Tardive Dyskinesia'?
Which condition presents with symptoms like 'Akathisia' and 'Tardive Dyskinesia'?
What is the main clinical manifestation of pseudohypoparathyroidism?
What is the main clinical manifestation of pseudohypoparathyroidism?
What is the role of parathyroid hormone (PTH) in response to decreased blood calcium levels?
What is the role of parathyroid hormone (PTH) in response to decreased blood calcium levels?
What effect does calcitriol have in response to PTH in the kidney?
What effect does calcitriol have in response to PTH in the kidney?
What is the function of PTH in calcium reabsorption in the kidneys?
What is the function of PTH in calcium reabsorption in the kidneys?
What is the main function of PTH when blood calcium levels are low?
What is the main function of PTH when blood calcium levels are low?
What diagnosis do you suspect for someone with kidney stones, nausea, vomiting, and bone pain? Labs: high serum calcium high PTH
What diagnosis do you suspect for someone with kidney stones, nausea, vomiting, and bone pain? Labs: high serum calcium high PTH
Which condition is characterized by round face, short stature, short 4th metacarpal bone with obesity and developmental delays due to a congenital mutation in the maternal GNAS-1 gene leading to end organ resistance to PTH?
Which condition is characterized by round face, short stature, short 4th metacarpal bone with obesity and developmental delays due to a congenital mutation in the maternal GNAS-1 gene leading to end organ resistance to PTH?
Which condition presents with similar features to pseudohypoparathyroidism but has no resistance to PTH and normal PTH and calcium levels?
Which condition presents with similar features to pseudohypoparathyroidism but has no resistance to PTH and normal PTH and calcium levels?
What parathyroid pathology is associated with an appropriate increased in PTH due to a problem with the end organ, such as the kidney or bone?
What parathyroid pathology is associated with an appropriate increased in PTH due to a problem with the end organ, such as the kidney or bone?
In which condition is there a chronic stimulation of the parathyroid gland leading to hypertrophy and overproduction of PTH due to longstanding diseases like chronic kidney disease?
In which condition is there a chronic stimulation of the parathyroid gland leading to hypertrophy and overproduction of PTH due to longstanding diseases like chronic kidney disease?
Which condition is characterized by a decrease in PTH levels alongside a rise in serum calcium?
Which condition is characterized by a decrease in PTH levels alongside a rise in serum calcium?
What is a common cause of primary acquired hypoparathyroidism?
What is a common cause of primary acquired hypoparathyroidism?
After a patient undergoes a partial parathyroidectomy, what complication may occur leading to severe hypocalcemia due to the suppression of remaining PTH?
After a patient undergoes a partial parathyroidectomy, what complication may occur leading to severe hypocalcemia due to the suppression of remaining PTH?
What is a common cause of low serum magnesium according to the text?
What is a common cause of low serum magnesium according to the text?
How does serum magnesium levels affect PTH secretion?
How does serum magnesium levels affect PTH secretion?
Which clinical sign results from tapping the facial nerve anterior to the earlobe?
Which clinical sign results from tapping the facial nerve anterior to the earlobe?
What is the name of the clinical sign involving carpal spasm induced by inflating a blood pressure cuff above systolic pressure?
What is the name of the clinical sign involving carpal spasm induced by inflating a blood pressure cuff above systolic pressure?
What is the primary function of parathyroid hormone (PTH) in response to decreased blood calcium levels?
What is the primary function of parathyroid hormone (PTH) in response to decreased blood calcium levels?
Which of the following conditions could result from hyperalbuminemia?
Which of the following conditions could result from hyperalbuminemia?
What effect does parathyroid hormone (PTH) have on phosphate levels in the body?
What effect does parathyroid hormone (PTH) have on phosphate levels in the body?
What is the main function of calcitriol in response to parathyroid hormone (PTH) stimulation in the kidney?
What is the main function of calcitriol in response to parathyroid hormone (PTH) stimulation in the kidney?
In primary hyperparathyroidism, what lab results are typically observed?
In primary hyperparathyroidism, what lab results are typically observed?
What is a common cause of secondary hyperparathyroidism?
What is a common cause of secondary hyperparathyroidism?
Which condition is associated with a really low or high magnesium levels alongside low PTH and corrected calcium?
Which condition is associated with a really low or high magnesium levels alongside low PTH and corrected calcium?
What condition results from longstanding chronic kidney disease and Vitamin D deficiency?
What condition results from longstanding chronic kidney disease and Vitamin D deficiency?
Which set of symptoms is more indicative of hypercalcemia?
Which set of symptoms is more indicative of hypercalcemia?
In primary hyperparathyroidism, what is the expected level of vitamin D?
In primary hyperparathyroidism, what is the expected level of vitamin D?
What is the most common etiology in primary hyperparathyroidism?
What is the most common etiology in primary hyperparathyroidism?
Study Notes
Parathyroid Disorders
Anatomy
- Located on the posterior surface of the thyroid gland
- Most people have 4 parathyroid glands (2 on each lobe), but may have as few as 2 or as many as 6
Physiology
- PTH (parathyroid hormone) is secreted by parathyroid chief cells into the bloodstream in response to decreased blood calcium levels
- PTH stimulates:
- Osteoclasts to resorb bone and release calcium into the bloodstream
- Renal tubular reabsorption of calcium and stimulates calcitriol synthesis from calcidiol in response to increased Ca2+ in the kidney
- Renal excretion of phosphate
- Calcitriol promotes calcium absorption in the small intestines
Calcium
- Normal range: 8.5-10.2 mg/dL
- Corrected calcium = serum calcium mg/dL + (0.8 x [4.0 – serum albumin g/dL])
- Hyperalbuminemia: dehydration, Multiple Myeloma
- Hypoalbuminemia: chronic illness, malnutrition
Hypercalcemia Presentation
- Nephrolithiasis
- Bone Pain (Osteitis fibrosa cystica)
- Constipation; N/V
- Weakness
- Lethargy
- Stupor
- Coma
- "Stones, Bones, Abdominal Groans, & Psychiatric Overtones"
Hypocalcemia Presentation
- Acute:
- Paresthesias (perioral, hands, feet)
- Increased Muscle Spasticity
- Chronic:
- Extrapyramidal symptoms:
- Akathisia
- Chvostek sign – facial spasm to rub
- Dystonia
- Trousseau sign – carpal spasm during BP
- Tardive dyskinesia
- Extrapyramidal symptoms:
Cardiac Involvement
- Heart failure
- Prolonged QT
- Parkinsonism
- Dementia
- Cataracts
- Poor Dentition
- Dry skin
Hyperparathyroidism
- 1º Hyperparathyroidism: problem with the parathyroid glands themselves
- 2º Hyperparathyroidism: problem with the end organ (bone or kidneys)
- 3º Hyperparathyroidism: chronic stimulation of the parathyroid glands causing hypertrophy and ultimately autonomous overproduction of PTH
Primary Hyperparathyroidism
- Most common cause of hypercalcemia
- Epidemiology: most common in African Americans, Women, 7th decade of life
- Etiology:
- Parathyroid adenoma (~80%)
- Gland hyperplasia (~20%)
- Carcinoma (~1%)
- Clinical Presentation: "stones, bones, abdominal groans, psychiatric overtones"
- Diagnosis:
- Calcium – elevated
- PTH – elevated
- Vitamin D – normal or elevated
- Phosphorous – normal or low
- Treatment:
- Parathyroidectomy
- Refer to surgery in all symptomatic patients or if calcium is >1 above ULN
- Consider referral for asymptomatic patients
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Description
Learn about the basics of parathyroid anatomy and physiology, including the location of the parathyroid glands on the thyroid and the role of parathyroid hormone in regulating blood calcium levels. Explore disorders related to the parathyroid glands.
