Summary: This week I thought we would move into disorders of the parathyroid as we just finished up the <a title="Physician Assistant Review Questions for the PANRE — Hypothyroid & Thyroiditis" href="http://www.physicianassistantexamreview.com/physician-assistant-review-questions-for-the-panre-hypothyroid-thyroiditis/">thyroid</a>. If you are interested in a more detailed review of the parathyroid glands I would visit <a href="http://www.parathyroid.com/">parathyroid.com</a>. They do an excellent job over there. The parathyroid produces parathyroid hormone (PTH). The parathyroid glands act to increase calcium levels in the blood. As you are no doubt aware, calcium plays a major role in physiology. Keep this in mind as you go through the symptoms of hyper and hypoparathyroidism. One example is the importance of calcium in muscle contractions. Hyperparathyroidism Like thyroid conditions hyperparathyroidism is three times as likely in women as in men. Primary disease is typically this is caused by an adenoma in one of the four parathyroid glands although could be from hyperplasia or carcinoma. An adenoma leads to excessive secretion of parathyroid hormone. Secondary disease may be associated with Chronic renal failure and poor production of vitamin D which will decrease Calcium, thereby stimulating the parathyroid glands malignant tumor -- breast, lung, pancreas Calcium deficiency Clinical Presentation “moans, groans, stones, and bones” patients will not usually come in complaining of any particular symptom. Hyperparathyroidism is usually an incidental finding. Muscles paresthesias muscle weakness decreased deep tendon reflexes Mental changes (Moans) general malaise depression cognitive impairment psychosis Heart HTN Prolonged P-R interval Shortened Q-T interval heart block GI (Abdominal Groans) constipation nausea/vomiting anorexia abdominal pain weight loss Kidney (Stones) hypercalcemia induced nephrogenic <a href="http://en.wikipedia.org/wiki/Diabetes_insipidus">diabetes insipidous</a> polyuria polydipsia Kidney stones Bone (Bones) bone pain arthralgia increased risk of pathologic fractures Skin pruritus Labs and Studies Blood work Ca > 10.5 elevated PTH is diagnostic phosphate low less calcimimetic Vitamin D Estrogen decreases serum Ca in a postmenopausal hyperparathyroidism Propranolol may be used to protect the heart against elevated Ca There will not be any questions on Thursday. We are going to cover hypoparathyroidism next week. I am going to combine those two topics into one set of questions. Check back next week for those.
