Fa: Endocrine - Pathology - 3

Front 1

What are the types of hyperparathyroidism? Levels of Calcium in each?

Back 1

- Primary: hypercalcemia
- Secondary: hypocalcemia
- Tertiary: hypercalcemia

Front 2

What is the most common cause of primary hyperparathyroidism?

Back 2

Parathyroid Adenoma

Front 3

How are hormones / electrolytes affected by Primary Hyperparathyroidism?

Back 3

- ↑ Ca2+: hypercalcemia and hypercalciuria
- ↓ PO4-: Hypophosphatemia
- ↑ PTH
- ↑ ALP
- ↑ cAMP in urine

Front 4

What are the most common symptoms of Primary Hyperparathyroidism?

Back 4

- Most often asymptomatic
- May present with symptoms of hypercalcemia: weakness and constipation ("groans"), abdominal / flank pain (kidney "stones", or acute pancreatitis), depression ("psychiatric overtones")

Front 5

What mnemonic helps you remember the symptoms of hypercalcemia?

Back 5

"Stones, bones, groans, and psychiatric overtones"
- Renal stones → abdominal / flank pain
- Bones → osteitis fibrosa cystica (cystic bone spaces filled with brown fibrous tissue causing bone pain)
- Groans → weakness and constipation
- Psychiatric overtones → depression

Front 6

What happens in Osteitis Fibrosa Cystica? Cause?

Back 6

- Cystic bone spaces are filled with brown fibrous tissue → bone pain
- Caused by hyperparathyroidism

Front 7

What causes Secondary Hyperparathyroidism?

Back 7

- Secondary hyperplasia due to ↓ gut Ca2+ absorption and ↑ PO4(3-)
- Most often in chronic renal disease (causes hypovitaminosis D → ↓ Ca2+ absorption)

Front 8

What are the hormone / electrolyte findings in Secondary Hyperparathyroidism?

Back 8

- ↓ Ca2+: hypocalcemia
- ↑ PO4-: hyperphosphatemia in chronic renal failure, although most other causes have hypophosphatemia
- ↑ ALP
- ↑ PTH

Front 9

How are the bones affected by Secondary Hyperparathyroidism or Tertiary Hyperparathyroidism?

Back 9

Bone lesions occur in 2° or 3° hyperparathyroidism due in turn to renal disease = Renal Osteodystrophy

Front 10

What causes Tertiary Hyperparathyroidism?

Back 10

Refractory (autonomous) hyperparathyroidism resulting from chronic renal disease

Front 11

What are the hormone / electrolyte findings in Tertiary Hyperparathyroidism?

Back 11

- ↑ Ca2+
- ↑↑ PTH

Front 12

What is the difference between secondary and tertiary hyperparathyroidism?

Back 12

Both commonly due to chronic renal disease
- 2°: ↓ Ca2+ and ↑ PTH
- 3°: ↑ Ca2+ and ↑↑ PTH

Both associated with renal osteodystrophy (bone lesions)

Front 13

What are the most common causes of hypoparathyroidism?

Back 13

Hypoparathyroidism:
- Accidental surgical excision of parathyroid glands
- Auto-immune destruction
- DiGeorge syndrome

Pseudohypoparathyroidism (Albright Hereditary Osteodystrophy)
- Autosomal dominant unresponsiveness of kidney to PTH

Front 14

What are the findings associated with hypoparathyroidism?

Back 14

- Hypocalcemia
- Tetany
- Chvostek sign
- Trousseau sign

Front 15

How do you check for a Chvostek sign? What does it indicate if it is positive?

Back 15

- Tap the facial nerve (tap the cheek)
- Positive: contraction of facial muscles
- Sign of hypoparathyroidism

Front 16

How do you check for a Trousseau sign? What does it indicate if it is positive?

Back 16

- Occlusion of brachial artery with BP cuff (cuff the TRiceps)
- Positive: carpal spasm
- Sign of hypoparathyroidism

Front 17

What is the other name for pseudohypoparathyroidism? Cause?

Back 17

Albright Hereditary Osteodystrophy
- Autosomal dominant unresponsiveness of kidney to PTH

Front 18

What are the symptoms of Albright Hereditary Osteodystrophy? Cause?

Back 18

- Hypocalcemia, shortened 4th/5th digits, and short sature
- Caused by autosomal dominant unresponsiveness of kidney to PTH (pseudo-hypoparathyroidism)

Front 19

Which PTH / Calcium pathology is associated with a low Ca2+ and a low PTH? Cause?

Back 19

Hypoparathyroidism:
- Surgical removal
- Autoimmune destruction

Front 20

Which PTH / Calcium pathology is associated with a low Ca2+ and a high PTH? Cause?

Back 20

2° Hyperparathyroidism
- Vitamin D deficiency
- Chronic renal failure

Front 21

Which PTH / Calcium pathology is associated with a high Ca2+ and a low PTH? Cause?

Back 21

PTH-independent hypercalcemia:
- Excess Ca2+ ingestion
- Cancer

Front 22

Which PTH / Calcium pathology is associated with a high Ca2+ and a high PTH? Cause?

Back 22

1° Hyperparathyroidism:
- Hyperplasia
- Adenoma
- Carcinoma

Front 23

What is the most common form of pituitary adenoma? Symptoms?

Back 23

Prolactinoma
- Amenorrhea
- Galactorrhea
- Low libido
- Infertility

Front 24

How do you treat a prolactinoma (pituitary adenoma)?

Back 24

Dopamine agonists:
- Bromocriptine
- Cabergoline

Front 25

What are the types of pituitary adenomas?

Back 25

- Functional (hormone producing, eg, prolactinoma)
- Non-functional (silent, present with mass effect)

Front 26

What is most likely wrong in a patient with amenorrhea, galactorrhea, low libido, and infertility?

Back 26

Prolactinoma (type of functioning pituitary adenoma)

Front 27

What is most likely wrong in a patient with bitemporal hemianopia, hypopituitarism, and a headache?

Back 27

Non-functional pituitary adenoma, causing problems due to mass effect

Front 28

What are the symptoms of a non-functional pituitary adenoma with mass effect?

Back 28

- Bitemporal hemianopia
- Hypopituitarism
- Headache

Front 29

What are the symptoms of a somatotropic pituitary adenoma?

Back 29

Acromegaly

Front 30

What is the cause of acromegaly?

Back 30

Excess GH in adults, typically caused by a pituitary adenoma

Front 31

What are the characteristic findings in a patient with Acromegaly?

Back 31

- Large tongue with deep furrows
- Deep voice
- Large hands and feet
- Coarse facial features
- Impaired glucose tolerance (insulin resistance)

Front 32

What is the name of the syndrome caused by increased GH in children? Symptoms? Cause of death?

Back 32

Gigantism
- ↑ Linear bone growth
- Cardiac failure most common cause of death

Front 33

How do you confirm a diagnosis of Acromegaly?

Back 33

- ↑ Serum IGF-1
- Failure to suppress serum GH following oral glucose tolerance test
- Pituitary mass seen on brain MRI

Front 34

How do treat a patient with Acromegaly?

Back 34

- Pituitary adenoma resection
- If not cured, treat with Octreotide (somatostatin analog) or Pegvisomant (GH receptor antagonist

Front 35

What drug is a GH receptor antagonist?

Back 35

Pegvisomant

Front 36

What drug is a somatostatin analog?

Back 36

Octreotide

Front 37

What drugs are dopamine agonists?

Back 37

- Bromocriptine
- Cabergoline