ABSITE ch 23 parathyroid

1. Embryologic origin of superior parathyroids

4th pharyngeal pouch

2. Location of superior parathyroids

Lateral to RLNs, above inferior thyroid artery

3. Embryologic origin of inferior parathyroids

3rd pharyngeal pouch

4. Location of inferior parathyroids

Medial to RLNs, below inferior thyroid artery

5. Most common ectopic site for parathyroids

Tail of thymus

6. Ectopic sites for parathyroids (4)

Tail of thymus, intrathyroid, posterior mediastinal, near tracheoesophageal

groove

7. Blood supply to all parathyroid glands

Inferior thyroid artery

8. Role of PTH

Increase serum Ca, increase Ca release from bone, increase Vit D production in
kidney

9. Role of Vitamin D in Calcium and phosphorus

Increase intestinal absorption by increasing calcium binding protein

10. Role of calcitonin

 Decrease serum Ca, decrease bone resorption of Ca, increase urinary Ca and
Phos excretion

11. Normal calcium level

8.5-10.5

12. Normal ionized calcium level

4.4-5.5

13. Normal PTH

5-40

14. Most common cause of hypoparathyroidism

Previous thyroid surgery

15. Oncogene that increases risk of parathyroid adenomas

PRAD-1

16. Lab values in primary hyperparathyroidism (Ca, Phos, Cl)

Inc calcium, dec phos, Cl:Phos ratio >33

17. Metabolic derangement seen in primary hyperparathyroidism

Hyperchloremic metabolic acidosis

18. Bone lesions from calcium resorption seen in hyperparathyroidism

Osteitis fibrosa cystica

19. Symptoms of hyperparathyroidism (4)

Stones (nephrolithiasis), bones (bone pain, patholological fractures, muscle

weakness, myalgia), groans (pancreatitis, PUD, constipation, nausea,
vomiting), psychiatric overtones (mental status changes, depression)

20. Indications for parathyroidectomy in primary hyperparathyroidism

 Symptomatic disease, Ca >13, dec creatinine clearance, substantially dec bone
mass

21. Most common cause of primary hyperparathyroidism

Single adenoma

22. Causes of primary hyperparathyroidism (3)

Adenomas (multiple or single), diffuse hyperplasia, parathyroid

adenocarcinoma

23. Treatment of parathyroid hyperplasia

Resect 3 � glands, or total resection + auto-implant

24. Half-life of PTH

18 minutes

25. Most common position of missing gland (at reoperation)

Normal anatomic position

26. Diagnostic imaging to localize parathyroids (2)

Thallium-technetium scan, Sestamibi-iodine scan

27. Increased PTH in response to low Ca, seen in patients with renal failure

Secondary hyperparathyroidism

28. Aluminum accumulation in bones after several years of hemodialysis

Renal osteodystrophy

29. Indications for surgery in secondary parathyroidism

Bone pain, fractures, pruritis

30. Increased PTH despite corrected renal disease

Tertiary hyperparathyroidism
31. Defect in PTH receptor in kidney causing increased resorption of Ca

Familial hypercalcemic hypocalciuria

32. Defect in PTH receptor in kidney which causes a lack of response to PTH

Pseudohyperparathyroidism

33. Most common location of parathyroid cancer mets

Lung

34. Treatment of parathyroid cancer

Parathyroidectomy and ipsilateral thyroidectomy

35. Mortality cause of parathyroid cancer

Hypercalcemia

36. Tumors seen in MEN1 (3)

Parathyroid hyperplasia, pancreatic islet cell tumors, pituitary adenoma

37. First part to become symptomatic in MEN1

Parathyroid

38. Most common pancreatic islet cell tumor in MEN1

Gastrinoma

39. Tumors seen in MEN2a (3)

Pheo, parathyroid hyperplasia, MTC

40. Most common symptom of MTC in MEN2a and 2b

Diarrhea

41. #1 cause of death in MEN2a and 2b

MTC
42. First part to become symptomatic in MEN2a

MTC

43. Tumors seen in MEN2b

Pheochromocytoma, MTC, mucosal neuromas

44. Gene implicated in MEN1

MENIN

45. Gene implicated in MEN2a and 2b

RET

46. Causes of hypercalcemia (11)

Calcium administration, hyperparathyroidism, immobility/iatrogenic, milk-

alkali syndrome, Paget�s disease, Addison�s disease, neoplasm, thiaZide
diuretics, excess vit D, excess Vit A, sarcoid/TB

47. Drug used in malignancies after failed conventional treatment; inhibits osteoclasts

Methramycin

48. Hormone released by breast cancer bone mets and SCLC causing hypercalcemia

PTHrp