parathyroid.txt

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Author:
nsmallwood
ID:
125082
Filename:
parathyroid.txt
Updated:
2011-12-27 07:24:55
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absite
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Description:
parathyroid
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  1. most common cause of hypothryoidism
    previous thryoid surgery
  2. normal pth
    10-60pg/ml
  3. normal parathyroid weight
    60-80 gm
  4. 90% of causes of hypercalcemia are from
    • hyperparathyroidism
    • calcium
  5. cancers that can release pth-rp
    lung, breast, renal
  6. cancer with highest risk of hypercalcemia
    small cell
  7. three mechanisms of increase calcium in malignancy
    • pth-rp
    • cytokines + excess vit D
    • osteolysis
  8. gene associated with hyperparathyroidism
    PRAD-1
  9. bone lesion from calcium resorption
    osteitis fibbrosa cystica
  10. familial hypercalcemic hypocalciuria is caused by what
    defect or increased sensitivity of PTH receptor
  11. indications for surgery in asymptomatic patients
    • Ca >13
    • decreased Cr clearance >30%
    • 24h urine Ca > 400 mg
    • age <50
  12. hyperparathyroidism in pregnancy
    resect in 2nd trimester
  13. if you can't find the adenoma and have looked in all locations what do you do then
    ipsilateral thyroidectomy and thymectomy
  14. signs of bone hunger
    normal pth and decreased hco3
  15. signs of graft or remnant failure
    decreased pth, normal HCO3
  16. labs in sec hyperparathyroidism
    • increase pth, PO4, urinary Ca
    • decrease Ca
  17. indications for surgery in sec hyperparathyroidism
    • refractory bone pain
    • refractory pruritis
    • fractures
  18. activates calcium sensing receptor in parathyroid and is used in sec hyperparathyroidism and hyperparathyroid cancer
    cinacalcet
  19. 1st manifestation of calciphylaxis
    skin ischemia and necrosis
  20. dx calciphylaxis
    skin bx
  21. increases the solubility of Ca depositis
    sodium thiosulfate
  22. phosphate binders which do not contain calcium
    • sevelamer (renagel)
    • lantanum carbonate (Fosrenol)
  23. tx of pseudo-hypoparathyroidism
    calcium
  24. MCC of hypercalcemic crisis
    previous hyperparathyroidism in a pt undergoing another procedure
  25. tx of hypercalcemic crisis
    • NS at 200-300cc/h
    • lasix
    • dialysis if refractory to above
    • chronically can use
    • bisphosphonates
    • calcitonin
    • steroids
    • mithramycin
  26. low Ca causes what ekg abnormality
    prolonged QT
  27. genes involved in MEN
    • MENIN- tumor suppressor
    • RET- protooncogene (TGF-beta tyrosine kinase receptor)
  28. manifestation of MEN
    • I- parathyroid hyperplasia, pancreatic, pituitary
    • IIA- para, medullary Ca of thyroid, pheo
    • IIB-medullary, pheo, mucosal gangioneuromas, marfans
  29. pheos in MEN are
    usually benign

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