Introduction Decreased production of parathyroid hormone (PTH) by chief cells of the parathyroid gland resulting in decreased plasma calcium levels increased plasma phosphate levels decreased 1,25(OH)2 Vitamin D levels Etiology iatrogenic thyroidectomy most common cause Pathophysiology decreased PTH levels cause decreased urinary excretion of phosphate at kidneys serum phosphate levels increase decreased conversion of inactive form of vitamin D to active form 1,25(OH)2-vitamin levels decrease Prognosis no current hormone replacement therapy available treatment is aimed at supplementing vitamin D and calcium levels Presentation Symptoms hypocalcemia more common in hypoparathyroidism neuromuscular irritability Chvostek's sign seizures tetany cataracts fungal infections of the nail hair loss skin changes vitiligo blotchiness of skin Imaging Radiographs skull basal ganglia calcification Evaluation Labs decreased PTH calcium 1,25-Vit D urinary calcium increased serum phosphate normal alkaline phosphatase pH alkalosis increases albumin binding to ionized calcium leads to hypocalcemia EKG prolonged QT interval Serum Ca Serum Phos PTH Common Cause Hyperparathyroidism ↑ ↓ ↑ adenoma Hypoparathyroidism ↓ ↑ ↓ thyroidectomy (including parathyroid) Ectopic PTH ↑ ↓ ↓ malignancy Vit D malabsorption ↓ ↓ ↑ celiac disease, other GI disease hypo vit D with no phosphate excretion from the kidney ↓ ↑ ↑ renal failure, pseudo hypoparathyroidism Treatment Nonoperative calcium and vitamin D supplementation indications decreased serum calcium level decreased levels of vitamin D outcomes must monitor labs on a regular basis
QUESTIONS 1 of 1 1 Previous Next (OBQ11.58) A patient with chronic renal disease would expect which of the following endocrine abnormalities? Tested Concept QID: 3481 Type & Select Correct Answer 1 Decreased production of PTH 10% (216/2256) 2 No change in production of PTH 2% (49/2256) 3 Increased production of PTH 87% (1969/2256) 4 Increased production of TSH 1% (13/2256) 5 Decreased production of TSH 0% (5/2256) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept