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Chapter: Medicine Study Notes : Endocrine and Electrolytes

Parathyroid

Usually detected as incidental finding. If symptoms: pain/fracture, renal stones, constipation, abdominal pain, depression. Also maybe dehydration, ­BP, thirst, nocturia, stuff joints, myopathy

Parathyroid

 

·        Calcium metabolism:


 

 

·        Hyperparathyroidism:

 

o   Primary: ­PTH ® ­Ca2+. 

§  Usually detected as incidental finding. If symptoms: pain/fracture, renal stones, constipation, abdominal pain, depression. Also maybe dehydration, ­BP, thirst, nocturia, stuff joints, myopathy

§  Associations: endocrine neoplasia (eg pancreas, pituitary, phaeochromocytoma and thyroid)

§  Causes: Single (90%) or multiple adenoma, carcinoma, hyperplasia 

§  Tests: ­Ca, ¯PO4 (unless renal failure), ­ALP, PTH raised or normal. CXR for „pepper pot skull‟ and pelvis

§  Treatment: surgery

o   PTH related protein (PTHrH): produced by some tumours – causes some of the hypercalcaemia seen in malignancy

 

o   Secondary Hyperparathyroidism: ¯Ca ® ­PTH. Causes: ¯Vitamin D and chronic renal failure (see 210 – complications of chronic renal failure)

 

o   Tertiary Hyperparathyroidism: continued secretion of PTH after prolonged secondary hyperPTH

 

 

·        Hypoparathryoidism:

 

o   Primary HypoPTH. Eg after neck surgery. ® ¯Ca and ­PO4, normal ALP. Associations with pernicious anaemia, Addison‟s, hypothyroidism, hypogonadism

 

o   PseudohypoPTH: Failure of target cell response to PTH. Round face, short metacarpals and metatarsals

 

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Medicine Study Notes : Endocrine and Electrolytes : Parathyroid |


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