Category 1: Physiology and Pathophysiology
This receptor on parathyroid cells senses calcium and regulates PTH secretion
What is the calcium-sensing receptor (CaSR)?
The most common cause of primary hyperparathyroidism.
What is a parathyroid adenoma?
he most common cause of secondary hyperparathyroidism.
What is chronic kidney disease (CKD)?
Tertiary HPT most often occurs after this event.
What is renal transplantation?
This life-threatening complication of parathyroidectomy requires immediate bedside wound opening.
What is Neck Hematoma
PTH increases serum calcium by acting on these three organs
This hereditary syndrome includes parathyroid tumors, pancreatic tumors, and pituitary adenomas.
What is MEN1?
This bone disease with high turnover is seen in advanced SHPT.
What is osteitis fibrosa cystica?
In tertiary HPT, both calcium and PTH levels are _____.
Elevated
The “Miami criterion” requires this drop in PTH level at 10 minutes.
What is a ≥50% drop from baseline?
PTH decreases reabsorption of this ion in the proximal tubule.
What is phosphate?
Name the classic 4-word mnemonic for PHPT symptoms.
What are “bones, stones, groans, and psychiatric overtones”?
In advanced CKD, secondary HPT transitions from diffuse to nodular hyperplasia. What receptor expression decreases, making the glands refractory to medical therapy?
What are CaSR and Vitamin D receptors (VDR)?
The definitive treatment for refractory tertiary HPT.
What is Subtotal Parathyroidectomy
This imaging modality uses technetium-99m to localize parathyroid adenomas.
What is sestamibi scintigraphy?
Name the three biochemical criteria in the “rule of 3’s” that should raise suspicion for parathyroid carcinoma
What is tumor size >3 cm, serum calcium >3 mmol/L (~12 mg/dL), and markedly elevated PTH?
The most common genetic driver of sporadic parathyroid adenomas
What is Cyclin D1 overexpression?
Name the bone histology pattern characterized by low bone turnover often caused by overtreatment of secondary HPT.
What is adynamic bone disease?
Explain why phosphate is typically low in tertiary HPT but high in secondary HPT.
What is restoration of renal clearance after transplant (tertiary), versus phosphate retention in CKD (secondary)?
Intraoperative PTH monitoring is unreliable in this patient population due to altered clearance.
Who are patients with chronic kidney disease? UremicHyperparathyroidism
This peptide hormone, secreted by osteocytes, downregulates calcitriol production and contributes to secondary HPT in CKD.
What is FGF-23?
In primary HPT, cortical bone is preferentially lost. Which DEXA site most clearly reflects this?
What is the distal one-third radius (forearm)
This rare complication of refractory SHPT presents with painful violaceous skin lesions and has a mortality of 30–80%.
What is calciphylaxis?
Definitive surgical management of tertiary HPT besides subtotal PTX is?>
What is total PTX with autotransplant (usually in forearm
During parathyroidectomy, injury to this nerve can cause temporary hoarseness in 5–10% and permanent injury in ~1% of patients.
What is the recurrent laryngeal nerve (RLN)?