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49 Cards in this Set
- Front
- Back
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What is a common cause of primary hyperparathyroidism?
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Adenoma of one parathyroid gland
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If four glands are affected, what diagnosis must be considered?
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Multiple endocrine neoplasia (MEN) syndrome
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What is the effect of primaryhyperparathyroidism on 1,25-vitamin D levels?
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Increased 1,25-vitamin D
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What is the effect of primary hyperparathyroidism on serum calcium concentration?
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Increased serum calcium
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What is the effect of primary hyperparathyroidism on serum phosphate concentration?
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Decreased serum phosphate
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What is the hydration status of hypercalcemic patients?
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Generally dehydrated as hypercalcemia leads to polyuria
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What is osteitis fibrosa cystica?
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Resorption of bone due to PTH overactivity and replacement with fibrous tissue
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What are the two characteristic histologic features of brown tumors?
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Giant cells
Hemosiderin |
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What are the other systemic effects of hypercalcemia?
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Renal stones
Psychiatric disorders Abdominal pain |
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What are the four available hypercalcemia treatment methods?
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Saline hydration
Loop diuretics Dialysis Mobilization |
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What is the most common cause of hypoparathyroidism?
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Iatrogenic
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What is the effect on serum calcium concentration?
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Decreased serum calcium
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What is the effect on serum phosphate concentration?
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Increased serum phosphate (because low PTH levels)
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What is the effect on 1,25-vitamin D levels?
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Decreased 1,25-vitamin D
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What is the characteristic radiographic finding on skull films?
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Calcification of the basal ganglia
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What is the cause of pseudohypoparathyroidism?
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No PTH effect at target cells
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Inheritance?
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X-linked dominant (XLD)
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Quick review: what other disorder has a similar inheritance pattern?
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Hypophosphatemic rickets
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What gene is involved?
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GNA51
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Mutation?
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oa(?) subunit
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Quick review; in what two other clinical situations do G-proteins play a vital role?
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Fibrous dysplasia
CaSR function |
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What is the PTH level in pseudohypoparathyroidism?
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Normal or high
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What is the serum calcium concentration?
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Low serum calcium
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What is the serum phosphate concentration?
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Elevated serum phosphate (again, no PTH effect)
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What is the effect on 1,25-vitamin D levels?
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Low 1,25-vitamin D
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Give an example of a disorder associated with pseudohypoparathyroidism?
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Albright syndrome
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What are the four characteristic features of pseudohypoparathyroidism?
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Short metacarpals
Bony exostoses Obesity Mental retardation |
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Quick review: what is another disorder that is associated with obesity and
mental retardation? |
Prader-Willi
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Pseudopseudohypoparathyroidism is phenotypically similar to what?
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Pseudohypoparathyroidism
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What is the serum calcium . concentration?
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Normal
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What is the target cell response to PTH?
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Normal
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What are the two general types of renal failure osteodystrophy?
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High turnover
Low turnover (excess aluminum leads to decreased metabolic activity) |
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With the high turnover type, what is the serum phosphate level?
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Elevated due to renal failure/inability to dump phosphate
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. . . . the serum calcium level?
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Low because with elevated phosphate, calcium precipitates out of solution
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. . . the PTH level?
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Elevated, because high phosphate levels lead to secondary
hyperparathyroidism |
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What are the two components of the treatment for high turnover renal osteodystrophy?
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Phosphate binders (antacids)
Activated oral vitamin D |
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With the low turnover type, what is the serum calcium level?
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Normal
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. . . the serum phosphate level?
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Normal
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. . the PTH level? .
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Low
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. . . the 1,25-vitamin D level?
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Low because of impaired renal hydroxylase
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With renal osteodystrophy, what is the clinical appearance of the spine?
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Rugger jersey spine
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What other disorder also exhibits a rugger jersey spine?
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Osteopetrosis
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What other generalized bony changes are present?
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Osteitis iibrosa cystica due to secondary hypoparathyroidism
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Chronic dialysis treatment also leads to what disorder?
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Amyloidosis
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With renal tubular acidosis, what two ions are lost in the urine?
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Sodium
Calcium |
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What is the key lab value for diagnosis?
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Urine calcium > serum calcium
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What is the treatment of renal tubular acidosis?
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Alkalinize the urine
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Renal tubular acidosis is phenotypically similar to what
disorder? |
Rickets
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Quick review: What are three other situations in which calcium losses can exceed intake?
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Postmenopausal woman (increased urine calcium, decreased absorption)
Elevated glucocorticoids (increased urine calcium) Osteogenic rickets (fibroblast growth Factor-23 [FGF-23]) |
