Disorders of Parathyroid Gland.ppt by UmarFarooq50

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									Disorders of Parathyroid Gland




              Dr Umar Farooq
Physiology

   Parathyroid hormone;
      Increases osteoclastic activity
     Increases renal tubular calcium reabsorption
     Stimulates synthesis of 1,25 vit D3.
   PTH secretion is stimulated by decreased
    serum calcium levels and vice vesa.
Hypoparathyroidism

 Causes
 Thyroidectomy
 Parathyroidectomy
 Autoimmune (isolated or associated with other
  endocrine deficiencies)
 PGA-Poly Glandular Autoimmunity
 (hypoparathyroidism,addison disease,thyroid disese
  etc)
Functional (hypomagnesemia)
Clinical features

   Tetany (muscle cramps,carpo-pedal
    spasm,irritabilty,convulsions,tingling of circumoral
    area,hands
   Lethargy
   Personality changes, anxiety
   Blurred vision
   Pakinsonism
   Mental retardation
   Defective teeth
Clinical features (contd;)

   Chvostek sign (facial muscle contraction on
    tapping of facial nerve in front of ear)
   Trousseau phenomenon (carpel spasm after
    applying sphigmomenometer)
   Cataract
   Brittle nail,scaly skin with candidiasis
   Brisk reflexes
   Papilledema
Investigations

   Seum calcium, phosphorus
   PTH
   Magnesium
   Radiograph/CT skull (denser bones,basal
    ganglia calcification)
   ECG (QT prologation)
   Slit lamp Exam (cataract0
Treatment

   Emergency treatment
       Airway
       Intravenous calcium gluconate
   Oral calcium
   Vitamin D (1,25 Calcitriol)
   Mg
   Transplantation of cryopreserved parathyroid
    tissue
Hyperparathyroidism

   Causes
     Adenoma
     Hyperplasia
     Carcinoma (rare)
     MEN 1,MEN 2A and B(multiple endocrine
    neoplasia)
    Chronic renal failure(secondary/tertiary)
Clinical features

   Asymptomatic
   Problems with “bones, stones, abdominal groans,
    psychic moans with fatigue overtones”
   Bone pains, cortical bone loss,bone cyst (brown
    tumour)
   Effects of hypercalcemia-paresthesia, muscular
    weakness, diminished tendon reflexes, dpression,
    fatigue, disorientation, psychosis, renal stones,
    polyuria, polydipsia, abdominal pain, weight loss,
    anorexia
Investigations

   Seum calcium
   Phosphorus
   Alkaline phophatase(bone disease)
   Vit D
   PTH
   ECG
Imaging

   Sestamibi-iodine subtraction scan
   CT/MRI
   Technetium 99m sestamibi scan
   Bone density by dual energy x-ray
    absorptiometry
   Skull x-ray mottling (salt n pepper)
   Loss of lamina dura of teeth
Treatment

   Asymptomatic patients
     No treatment
     keep active
     avoid immobility
     drink adequate fluids
     monitor
Treatment

   Parathyroidectomy
   Indications
   Seum calcium 1 mg above the upper normal limit
    and urine calcium more than 50 mg/24 hour
   Urine calcium more than 400mg/24 hours
   Cortical bone density 2SD below normal
   Relative youth
   Difficulty in medical follow up
   pregnancy
Medical management

   Fluids
   Bisphosphonates (pamidronate,
    zolentronate) for severe hypercalcemia in
    preparation for sugery
   Cinacalcet- binds to parathyroid calcium
    receptors and increases calcium affinity
   Cacitriol –secondary and tertiary
    hyperparathyroidism

								
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