Alterations of Parathyroid Function & Endocrine Pancreas

What is hyperparathyroidism?

When the parathyroid gland is hyperactive, and secretes too much PTH

Compare Primary & Secondary hyperparathyroidism

Primary hyperparathyroidism

• Parathyroid gland itself is the problem (benign adenoma); overworking on its own

• High calcium, low phosphate

Secondary hyperparathyroidism

• External factors triggers extra PTH, chronic Hypocalcemia

• Stimulates glands continuously, overproduce PTH

What are the manifestations of hyperparathyroidism?

• Hypercalcemia

• Hypophosphatemia

• Hypercalciuria: kidney stones

• Pathological fractures

What is Hypoparathyroidism?

Abnormally low PTH levels

What usually causes hypoparathyroidism?

Parathyroid damage in thyroid surgery

What are the manifestations of hypoparathyroidism

• Hypocalcemia

• Chvostek’s and Trousseau’s signs

• Hyperphosphatemia

What is Chvostek’s and Trousseau’s signs?

Chvostek’s - twitching of face upon physical stimulation

Trousseau’s - spasms of arm when inflating BP cuff

What is Type I Diabetes Mellitus?

Chronic autoimmune disease where body’s immune system destroys pancreatic B-cells in the islets of Langerhans, decreasing insulin

What are the two types of Type I Diabetes Mellitus?

• Idiopathic type 1

  • No clear autoimmune cause, no autoantibodies

  • B-cell loss happens but with an unknown mechanism

• Autoimmune type 1

  • Most common

  • Caused by immune-mediated destruction of pancreatic B-cells

  • Positive autoimmune markers

What are the manifestations of Type I Diabetes Mellitus?

• Hyperglycemia

• Polydipsia

• Polyuria

• Polyphasic

• Weight loss

• Fatigue

What is Type II Diabetes Mellitus?

A chronic metabolic disorder where the body becomes resistant to insulin and the pancreas can’t produce enough to keep up

What causes T2DM?

• Genetic-environmental interaction

  • Family history increases susceptibility

  • Lifestyle (obesity, sedentary lifestyle, diet) trigger or worsen the disease

What are the risk factors of T2DM?

• age

• Obesity

• Hypertension

• Physical activity

• Family history

What is metabolic syndrome?

Cluster of health conditions that occur together, increasing the risk of type II diabetes, heart disease & stroke

What is the early defect in T2DM?

Initial insulin resistance

What happens to B-cells later in Type II Diabetes?

Progressive loss of B-cell function

What is the two-step progression of T2DM?

• Initial insulin resistance

• Later loss of Beta cells

What are the manifestations of T2DM?

• Fatigue

• Pruritus (itching)

• symptoms of neuropathy

• Overweight

• Dyslipidemic

• Hyperinsulinemic

• Hypertension

What are other types of diabetes Mellitus?

• Maturity onset diabetes of youth (MODY)

  • Rare, inherited form caused by monogenic mutations that affect pancreatic function

• Gestational diabetes Mellitus (GDM)

  • Any degree of glucose intolerance with onset or first recognition during pregnancy

What are the acute complications of diabetes Mellitus?

• Hypoglycemia (treated)

• Diabetic Ketoacidosis (DKA)

• Hyperosmolar Hyperglycemic Syndrome (HHS)

What are the microvascular diseases that arise from chronic diabetes Mellitus?

• Diabetic retinopathy

• Diabetic nephropathy

• Diabetic neuropathies

What are the macrovascular diseases that arise from chronic diabetes Mellitus?

• CV disease

• Stroke

• PV disease

What chronic complications arise from diabetes Mellitus?

• Microvascular disease

• Macrovascular disease

• Infection