Diff Dx: Final - Pth And Adrenal

Front 1

Role of PTH

Back 1

Inc release of Ca and Phosphate from bones
Inc absoprtion of Ca and phosphate by kidneys
Promote Ca absorption in GI tract

Front 2

Age and sex of Hyperparathyroidism

Back 2

Women 2x more than men
Most like >60 yo

Front 3

Etiology of hyperparathyroidism

Back 3

PRIMARY: Regulatory relationship btw serum calcium and PTH is interrupted - the balance gets inteupted due to: adenoma, hyperplasia in the gland
SECONDARY: glands become hyperplastic due to malfxt of another sytem seen in kidney dx and padget's dx
TERTIARY: PTH is inc or overactive in ppl with low serum Ca levels

Front 4

Primary and secondary causes of hyperparathyroidism

Back 4

Primary: adenoma and hyperplasia of gland
Secondary: Kidney dx and padget's dx

Front 5

General clinical manifestations of hyperparathyroidism

Back 5

Bone damage
Due to hypercalcemia: abdominal pain, peptic ulcers, pancreatitis, kidney damage, muscle symptoms, nuerological symptoms

Front 6

What happens to bone in parahyperthyroidism

Back 6

Excess extraction of Ca from bone leads to bone damage
Demineralization of bone, lytic bone lesions, fractures, and pain

Front 7

Kidney issue with parahyperthyroidism

Back 7

Deposite of cacium phosphate in renal tubule
Nephrocalcinosis
Kidney stones b/c calcium salts are insoluble in urine

Front 8

Muscle symptoms due to hyperparathyroidism

Back 8

Paresthesia, mm cramps, loss of pain and vibratory sensation along a stocking glove distribution

Front 9

Diagnosis of hyperparathyroidism

Back 9

Elevated serum Ca
Serum phosphate dec'd (counterintuitive but true)
High levels of Ca and phosphorus in urine
Diffuse demineralization on X-ray

Front 10

PT implications for hyperparathyroidism

Back 10

Chronic LBP
Marked mm weakness/atrophy
CPPD (gout in 35% of cases)
Osteogenic synovitis in achilles and triceps
Inc'd risk of fx

Front 11

Hypoparathyroidism:
Ca and phosphate levels
Etiology
Sex and age

Back 11

Low Ca, high phosphate
Latrogenic (accidental removal) or idioathic
Children 9x more than adults, Women 2x more than men

Front 12

Clinical manifestations of Hypoparathyroidism

Back 12

Bone resrption dec's
Severe NM irritability
Calcification o various organs = eye and BG

Front 13

Severe symptoms down the line of hypoparathyroidism

Back 13

Tingling in finger tips and around mouth
Progresses to tetani during exacerbations

Front 14

Dx of hypoparathyroidism

Back 14

Hx and clinical presentation
Lab values: dec Ca and high phosphate

Front 15

Signs of acute tetany with hypoparathyroidism

Back 15

Minor mm twitching
Laryngospasm (voice)

Front 16

What does therapy revolve around for hypoparathyroidism?

Back 16

Gait training
Technique to prevent falls

Front 17

What is secreted by the adrenal cortex and main function?

Back 17

Mineralcorticoids - Steroid hormone imp in regulating fluid and mineral balance
Glucocorticoids - Steroid hormone responsible for controlling glucose metabolism
Androgens - sex hormone

Adrenal glands are small glands on the upper part of the kidney

Front 18

Difference between Cushing's syndrome and dx

Back 18

Syndrome - excessive glucocoricoids due to externally administered cortisol--commonly occurs in autoimmune dz or post-transplant
Dx - Hypercortisolism due to excess excretion of ACTH (primary cause = pituitary hypersecretion due to pituitary or adrenocorticol tumors)

Front 19

What do inc levels of cortisol cause?

Back 19

Inc'd liberation of AA from mm
Weakening of protein stucture
Protuberant abdomen with striated stretch marks
Generalized mm weakness
Marked osteoporosis (secondary to loss of Ca thru urine)

Front 20

Primary tx of Cushing's Disease?

Back 20

Radiation (if tumor of pituitary or adrenal cortex)
Drug therapy
Surgery

Goal is reduction of cortisol levels

Front 21

What is Conn's syndrome? Cause

Back 21

Excess release of Aldosterone from adrenal cortex
Primary cause: Adrenal lesion which leads to hypersecretion
Secondary: Renal HTN, sclerosis of the liver, and cardiac failure

Front 22

Consequences of too much Aldosterone (Conn's syndrome)

Back 22

Inc resorption of Na and H2O by kidney
Hypernatremia
Hypervolemia
Hypokalemia
Metabolic alkalosis

Front 23

Clinical presentation of Conn's dx

Back 23

HTN
CVA
Heart failure
Visual disorders
MM weakness
Excess thirst
DM

Front 24

Tx of Conn's dx

Back 24

diuretics
Beta blockers
Remove or radiation of hypersecreting tumors

Front 25

Causes of Primary adrenal insufficiency

Back 25

Addison's dx (main cause)
Bilateral adrenectomy
Adrenal hemorrhage or inflammation
Radiation
Malignant adrenal neoplasm
Infections (cytomegalovirus)
Chemical agents

Front 26

Etiology of Addison's dx

Back 26

Idiopathic or autoimmune

Front 27

Risk factors for developing or exacerbating adrenal insufficiency

Back 27

Surgery
Prego (postpartum hemorrhage)
Injury or trauma
Salt loss d/t diffuse diaphoresis
Failure to take steroid therapy in person with Addison's dx

Front 28

Outcome of Adrenal insufficiency

Back 28

Dec'd cortisol
Glucoeneogenesis dec'd
Glycogen deficiency
Hypoglycemic: weak, exhausted, hypotensive, anorexia, wt loss, n/v, emotional disturbance (depresseon and dec'd resistance to stress)

Front 29

What happens to ACTH with primary adrenal insufficiency?

Back 29

Increases due to neg feedback loop
Causes inc in MSH too which results in hyperpigmentation (bronzed, tanned look)

Front 30

What does dec'd aldosterone result in in adrenal insufficiency?

Back 30

Hyponatremia and hyperkalemia = hypotensive
Could cause circulatory colaps
Dec tolerance to minorstress, ppor coordination, craving for salty foods, retard axillary and pubic hair growth in females, dec'd libido, amenorrhea

Front 31

Dx and tx of adrenal insufficiecy

Back 31

Dx: blood, urine, and hormonal assays
Tx: life long administration of synthetic corticosteroids

Front 32

Function of Aldosterone

Back 32

Increase the reabsorption of Na+ and H20 and increases the release or secretion of potassium

Causes increased blood volume