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23 Cards in this Set
- Front
- Back
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Embryonic precursor of superior parathyroid gland.
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4th and 5th pharyngeal pouch
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Embryonic precursor of inferior parathyroid gland.
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3rd pharyngeal pouch
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What structures do 4th and 5th pharyneal pouch develop into?
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superior parathyroid gland
thyroid C cells (parafollicular) |
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What structures do 3rd pharyngeal pouch develop into?
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inferior parathyroid gland
thymus |
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What type of parathyroid cells do you see in this image?
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- chief cells: basophilic, look clear if more glycogen, screte PTH
- oxyphil cells: many mitochondria, do not secrete PTH - fat |
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Is this parathyroid section from a young or an old adult?
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young adult
- 50-90% cells - rest is fat |
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Is this parathyroid section from a young or an old adult?
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old adult
- 30-60% cells - oxyphil cell nodule |
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What are some symptoms of hyperparathyroidism?
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- groans (GI)
- bones (resorption) - stones (urinary) - moans (psychic) |
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Primary vs. secondary vs. tertiary hyperparathyroidism?
- high PTH - high/normal Ca2+ |
primary hyperparathyroidism
- one or more parathyroid gland secrete excess PTH which leads to hypercalcemia |
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Primary vs. secondary vs. tertiary hyperparathyroidism?
- high PTH - low/normal Ca2+ |
secondary hyperparathyroidism
- conditions that chronically lowering serum Ca2+ (hypercalciuria) -> high PTH |
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Primary vs. secondary vs. tertiary hyperparathyroidism?
- high PTH - high/normal Ca2+ - previousely had secondary hyperparathyroidism |
tertiary hyperparathyroidism
- autonomous PTH secretion develops after secondary hyperparathyroidism |
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What are some common causes of primary hyperparathyroidism?
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- adenoma in one gland (75-85%)
- 4 gland hyperplasia (10-15%) - carcinoma (1-3%) - double adenoma: rare |
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What is the most common cause of primary hyperparathyroidism?
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adenoma in one gland
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What is this parathyroid disease?
gross - 1 gland > 1cm, 300mg - encapsulated, red-brown - compressed normal yellow-tan parathyroid Lab - high PTH - high Ca2+ - may be hemorrhagic or cystic |
adenoma
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What is this parathyroid disease?
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parathyroid adenoma
- sheets of cells - no intracellular or stromal fat - atypical nuclei - compressed normal gland |
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What is this parathyroid disease?
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oxyphilic cell adenoma - a variant of parathyroid adenoma
- large cells - cytoplasm packed with mitochondria |
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What is this parathryroid disease?
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lipoadenoma- a variant of parathyroid adenoma
- solid nests of chief and oxyphil cells mixed with mature fat |
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What is this parathyroid disease?
- all 4 glands greater than 55mg - all are hypercellular |
4 gland hyperplasia
- chief cell hyperplasia (including water clear cells) - solid and follicular patterns |
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What is the tumor genetics of parathyroid carcinoma?
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- loss of Rb tumor suppressor gene
- over-expression of cyclin D1 - reduced expression of CDK inhibitor P27 |
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What is the most common cause of secondary hyperparathyroidism?
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chronic renal failure
- reduced alpha1-hydroxylase activity -> less vitD -> low serum ca - reduced GFR -> phosphate retention -> increased serum phosphate -> decreased serum Ca - decreased serum Ca -> increased PTH with 4 gland hyperplasia -> increased bone resorption -> osteitis fibrosa cystica |
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What is this condition?
- low serum Ca - low serum PTH |
hypoparathyroidism
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What are some common causes of hypoparathyroidism?
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- surgical removal during thyroidectomy
- congenital (diGeorge syndrome) - familial hypoparathyroidism: AIRE mutation (APS1) - idiopathic |
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What is this condition?
- Chvostek sign - Trousseau sign - anxiety, depression, instability - cataracts, lens calcifications - QT prolongation |
- low ionized serum Ca -> neuromuscular irritability -> tetany
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