Parathyroid Glands Anatomy
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Questions and Answers

How many parathyroid glands are typically found in the human body?

  • 4 (correct)
  • 8
  • 6
  • 2

    • What is the typical color of parathyroid glands in children?

  • Pinkish (correct)
  • Golden-yellow
  • Light brown
  • Yellow/brown

    • What is the origin of superior parathyroid glands?

  • Endoderm of 4th branchial arch (correct)
  • Endoderm of 3rd branchial arch
  • Mesoderm of 4th branchial arch
  • Ectoderm of 4th branchial arch

    • Where are superior parathyroid glands typically located in relation to the recurrent laryngeal nerve?

    <p>Dorsal to RLN</p> Signup and view all the answers

    What is the weight range of superior parathyroid glands?

    <p>20-40 mg</p> Signup and view all the answers

    What is the condition characterized by hyperexcitability of peripheral nerves?

    <p>Tetany</p> Signup and view all the answers

    Which of the following is a cause of tetany?

    <p>Hypoparathyroidism</p> Signup and view all the answers

    What is the potential location of inferior parathyroid glands in rare cases?

    <p>All of the above</p> Signup and view all the answers

    What is the primary symptom of latent tetany?

    <p>Cramps of the hands and feet</p> Signup and view all the answers

    What is the primary cause of hyperparathyroidism?

    <p>Unknown</p> Signup and view all the answers

    What is the result of spasm of intraocular muscles?

    <p>Blurring of vision</p> Signup and view all the answers

    What is the primary feature of renal disease in hyperparathyroidism?

    <p>Renal stones</p> Signup and view all the answers

    What is the effect of lithium on the parathyroid glands?

    <p>Hyperplasia</p> Signup and view all the answers

    What is the primary feature of bone disease in hyperparathyroidism?

    <p>Painful bones</p> Signup and view all the answers

    What is the primary feature of abdominal presentation in hyperparathyroidism?

    <p>Abdominal pain</p> Signup and view all the answers

    What is the primary feature of muscle disease in hyperparathyroidism?

    <p>Proximal myopathy</p> Signup and view all the answers

    What is the purpose of measuring serum albumin levels in hyperparathyroidism?

    <p>To assess the binding capacity of calcium</p> Signup and view all the answers

    What is the diagnostic investigation for hyperparathyroidism?

    <p>Serum PTH level estimation</p> Signup and view all the answers

    What is the typical serum calcium level in hyperparathyroidism?

    <p>9-11 mg%</p> Signup and view all the answers

    What is the significance of alkaline phosphatase in hyperparathyroidism?

    <p>It is elevated when bones are involved</p> Signup and view all the answers

    What is the surgical treatment for a single parathyroid adenoma?

    <p>Excision of the gland and removal of one normal parathyroid gland</p> Signup and view all the answers

    What is the surgical treatment for diffuse hyperplasia?

    <p>Removal of three parathyroid glands and autotransplantation</p> Signup and view all the answers

    What is the indication for surgery in hyperparathyroidism?

    <p>Only for symptomatic patients</p> Signup and view all the answers

    What is the surgical treatment for parathyroid carcinoma?

    <p>Removal of all four parathyroid glands and ipsilateral thyroid lobe</p> Signup and view all the answers

    Study Notes

    Parathyroid Glands

    • There are 4 parathyroid glands, 2 on the right and 2 on the left side of the neck.
    • They secrete the hormone parathormone (PTH) independently of the pituitary gland.
    • Parathyroid glands are typically yellow/brown in color, described as "Portland brick."
    • In children, they are pinkish, and in adults, they are golden-yellow to light brown.

    Superior Parathyroids

    • Derived from the endoderm of the 4th branchial arch.
    • Develop along with the thyroid gland.
    • Located in the middle of the posterior aspect of the thyroid gland, in relation to the inferior thyroid artery.
    • Constant in position, smaller (20-40 mg), and dorsal to the recurrent laryngeal nerve (RLN).

    Inferior Parathyroids

    • Derived from the endoderm of the 3rd branchial arch (with thymus).
    • Not constant in position.
    • May be located in the lower pole, within the fascial sheath of the thyroid gland, low down in the neck, or outside the fascial sheath.
    • Larger (30-50 mg) and ventral to the RLN.

    Causes of Tetany

    • Hypoparathyroidism.
    • Severe respiratory alkalosis.
    • Low calcium levels.
    • Osteomalacia and rickets due to vitamin D deficiency.
    • Hypokalaemic alkalosis of pyloric stenosis.
    • Following massive transfusion (citrate overload).

    Signs and Symptoms of Tetany

    • Tingling and numbness of the fingers, toes, lips, and occasionally, circumoral pallor.
    • Cramps of the hands and feet.
    • Carpopedal spasm.
    • Stridor.
    • Latent tetany can be diagnosed by Chvostek's sign and Trousseau's sign.
    • Spasm of intraocular muscles results in blurring of vision.
    • Convulsions.

    Hyperparathyroidism (HPT)

    • An uncommon disease that occurs due to parathyroid activity, manifesting as hypercalcaemia.
    • Primary hyperparathyroidism (PHPT) can be caused by genetic mutations, lithium, and low-dose therapeutic ionizing radiation.
    • Renal leak of calcium and declining renal function with age may also be causative factors for PHPT.

    Primary Hyperparathyroidism (PHPT)

    • Familial/genetic: Can be part of MEN syndrome - I and MEN IIA, or familial PHPT with jaw tumor syndrome.
    • Exact cause of primary hyperparathyroidism is unknown.
    • Lithium is associated with parathyroid hyperplasia and primary HPT.

    Symptoms of Hyperparathyroidism

    • Painful bones (bone disease).
    • Renal stones (renal disease).
    • Abdominal groans.
    • Psychiatric moans.
    • Fatigue overtones.
    • Abdominal pain.
    • Oliguria.
    • Corneal calcification/band keratopathy.
    • Proximal myopathy.
    • Muscle wasting.

    Investigations

    • SPECT: Useful in evaluating ectopic parathyroid adenomas.
    • Serum calcium levels are always raised above normal limits (9-11 mg%).
    • Albumin is the main calcium-binding protein in the plasma and should be measured.
    • Serum PTH level is estimated by immunoassay and is the diagnostic investigation.
    • Serum phosphorus levels are decreased.
    • Alkaline phosphatase is increased when bones are involved.

    Indications for Surgery

    • All symptomatic patients should be offered surgery.
    • Types of surgery include:
      • Single adenoma: Excision of the gland and removal of one normal parathyroid gland for histopathological study.
      • Diffuse hyperplasia: Removal of 3 or 3 parathyroids and autotransplantation into the forearm muscle tissue.
      • Carcinoma: Removal of all four glands, along with the ipsilateral thyroid lobe, and modified radical neck dissection in the presence of lymph node metastasis.

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    Description

    Learn about the surgical anatomy of parathyroid glands, including their location, color, and function in secreting parathormone (PTH).

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