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Hyperparathyroid 75% are Asymptomatic

ism
Painful bones
(osteoporosis) Renal
stones
Abdominal groans
Psychic moans
Primary: Intrinsic gland
dysfunction
an enlargement of one or
more of the parathyroid
glands causing
overproduction and high
calcium blood levels
(hypercalcemia
Signs

TX

Hyperthyroidism

Graves
Toxic multinodular goiter
Toxic adenoma
TSH Secreting Pituitary
adenoma

excess of parathyroid
hormone in the bloodstream
due to overactivity of one or
more of the body's four
parathyroid glands.
Secondary: Gland
hyperactivity from
hypocalcemia or Vit D
deficiency
result of another disease
that causes low levels of
calcium in the body.
Hypetension
Band Keratopathy
Osteoporosis
Atrophy of proximal muscles
Mental confusion
Elevated serum calcium
levels (fasting)
Increased PTH suggests
primary type due to
parathyroid adenoma or
hyperplasia,
Hypercalcemia
Increased PTH suggests
secondary due to chronic
kidney failure which leads
to hypocalcemia, vit D
deficiency
Primary
Surgery
Secondary
Vit D/Calcium
supplementation if
secondary
Treat hypercalcemia if
symptomatic (IV fluids,
furosemide, calcitonin)
Biphosphonates
excess thyroid hormone
Thyrotoxicosis
Accelerates bodys
metabolism

Symptoms
Fatigue
Weakness
Heat Intolerance
Palpitations
Nervousness Emotional
lability

Signs
Skin
Eyes
Cardiovascular
Neuro
Musculoskeletal
Psych/Emotional

Labs/Tests and
Diagnosis

Thyroid Function Tests


Examples
Low TSH
High Serum T3, T4
RAIU (Uptake on scan)
Methimazole
Propylthiouracil
Beta Blockers
(propanolol)
Surgery
decreased free thyroid
hormone or from resistance
to hormone action

First line tx

Hypothyroidism

Osteoporosis

Types
Hashimotos
Silent (lymphocytic)
Post-partum
De Quervains
Medication induced
Thyroiditis
Signs
Dry coarse skin
Dull facial expression
Husky voice
Delayed deep tendon
reflexes
Reduced body and scalp
hair
Increased weight
Cold intolerance

Symptoms
Weakness, fatigue,
lethargy
Cold Intolerance
Decreased memory
Constipation
Modest weight gain
Depression
Dry skin

Labs

Treatment

Thyroid Function Tests


Examples
High TSH
Low Serum T3, T4
Thyroid antibodies
Levothyroxine (synthroid)

Primary

Secondary

Acromegaly

Postmenopausal
Those at risk:
Caucasians, Asians,
thin body habitus,
smoking, steroids,
kidney dz, ETOH use,
low calcium and vitamin
D diets, physical
inactivity
Symptoms/Signs
Often asymptomatic
Pathologic fractures
Spine compression
Back pain

Cushings Syndrome,
thyrotoxicosis

Labs/Diagnosis

Dexa scan: show extent of


dimineralization
X-rays: dimineralization
(osteopenia)

TX

Vitamin D
Exercise
Biphosphonate
Selective Estrogen Receptor
Modulator
Estrogen
Calcitonin

Too much growth


hormone during
adulthood

bones increase in size,


including those of your hands,
feet and face. Acromegaly
usually affects middle-aged
adults.
GH and IGF-I
measurement.
Growth hormone
suppression test.
Imaging.
Surgery
Medication
Somatostatin analogues
Dopamine agonists.
Growth hormone
antagonist
Radiation

Labs

Treatment

Diabetes Insipidus

Description
Defective regulation of
water balance

Loss of bone density


(brittle bones)
Demineralization and
decreased matrix
Degeneration of already
constructed bone

Causes
Inadequate secretion of
vasopressin from pituitary

Central
Inadequate secretion of
vasopressin from
pituitary gland

gland rate of fluid by


kidneys influence production
anti-diuretic hormone (ADH),
also called vasopressin.
Nephrogenic
Kidneys failure to respond
to vasopressin

Symptoms

Polydipsia
Polyuria
Nocturia
Dehydration
Headache
Visual Disturbance

Labs/Diagnosis

Fluid Deprivation
Desmopressin
Urine
electrolyte levels
Osmolality
Glucose

Treatment

Correct water deficits


Desmopressin for central
DI
Low salt diet or
hydrochlorothiazide for
nephrogenic DI