PARATHYROID AND ADRENAL GLANDS - PowerPoint Presentation

Slide1

PARATHYROID AND ADRENAL GLANDS

D

r

.

Z

aeem

dahla

Consultant General &

Laparoscopic

S

urgeon

Slide2

Parathyroid glands

Learning Objective

A-To understand the development &anatomy of parathyroid.

B-TO understand the physiology, function &

investigation of PT.

C-To describe management , risks & complications of parathyroid surgery

.

Slide3

Slide4

EMBERIOLOGY

THE foramen

caecum at the base of the tongue is a remnant of thyroglossal duct this hallow structure migrate caudally and pass in close continuity with, and some times through the developing hyoid cartilage.

The PTGs

develop from the 3rid&4

th

pharyngeal pouch.

The thymus

gland also develop from 3rid pharyngeal pouch

As it descend to superior mediastinum , in thorax it take with it the PTG which arise from 3rid pharyngeal pouch take the inferior site in regards to it upper pouch.

THYROID GLAND

; usually arise from the 4

th

pharyngeal pouch.

Slide5

Surgical anatomy & physiology

The normal PTG weight up to 50mg with charterstic orange\brown colour .

Most adult have 4 glands,2 superior,2 inferior , but may have more than 4 glands,.

Superior PTG usually constant in its position , while the inferior PTG have non fixed position.

Upper PTH glands found in a fat tissue above on the posterolateral border of the thyroid immediately above the point of entry of the inferior thyroid artery.

Slide6

Slide7

Slide8

Slide9

The lower pair of PTG , more variable in position , are usually found at the lower pole of thyroid ,but may be found anywhere along a line from this situation downwards to the upper pole of thymus . Approximately 5% of PTGs are found within the upper anterior mediastinum . each gland has small capsule and is supplied by a single leash of blood vessels , theses glands are usually lie outside thyroid gland capsule.

Slide10

Histology;

The stroma consists of rich sinusoidal capillary net work with islands of secretory cells , two type of cells . The ‘ chief ’ cells or principle cells are small with vesicular nuclei and poorly staining cytoplasm. ‘oxyphil ’ cell are less numerous and larger , with granular cytoplasm and deeply staining .

Slide11

FUNCTION.

Chief cells give P.T.H also called parathormone, the hormone released directly into the blood.the circulating level of this hormone can be measured by radio-immuno-assay.it is sufficiently reliable to distinguish between high and low levels.

Slide12

FUNCTION OF PARATHYROID HORMONE

Stimulate osteoclast activity, thereby increase bone resorption by mobilizing calcium and phosphate.

Increase the reabsorption of calcium by renal tubules; thus reducing urinary secretion of calcium

Augment the absorption of calcium from the gut.

Reduce renal tubular re absorption of phosphate , thus promoting phosphate urea.

Slide13

Calcitonin hormone

Was once thought to be the second parathyroid hormone , but is now known to be secreted by thyroid from the ‘parafolicular cells ‘ ( c cell) its action quite the opposite action of parathormone

.

Slide14

Disease of parathyroid glands

Hypo parathyroidism

Hyper parathyroidism

Slide15

hypoparathyroidism

Parathyroid titany is a rare complication of subtotal thyroidectomy (less than 1%)

Symptoms usually appear on the 2

nd

or 3d post oprative day, and are temporary .

Permanent hypoparathyroidism, most commonly encountered following radical thyroidectomy ,this require constant supervision and treatment .

Titany in newborn may occur within the first few days of life in the child born of a mother with un diagnosed hypo parathyroidism.

Slide16

Clinical feature

The 1

st

symptoms are tingling and numbness in the face ,fingers, toes.

In extreme cases cramps in the hands and feet's are very painful ,the extended fingers are flexed metacarpi- phalangeal joints with thumb strongly adducted .

This called ( capo pedal spasm)

Slide17

Slide18

Spasm of respiratory muscle.In infancy symptoms of titan may be mist taken for epilepsy , though there is no loss of consciousness.

Latent titan maybe demonstrated by :

# chvostek’s sign

# trousseau’s sign

Slide19

Treatment

In acute cases the symptoms can be qiuckly and effectively relieved by slow iv injection 10-20 ml of 10% of calcium gluconate ,this can be repeated till the serum ca level has been established .

Oral vitamen D

(increase ca absorption from GIT) and calcium lactate .

Initial dose 400000 units of calciferol may be followed by 100000 units ,daily till serum ca level become normal.

Slide20

Slide21

Hyperparathyroidism

Symptoms of over activity of the para thyroid gland may result from single or multiple adenoma (85%)

Hyperplasia of all 4 glands 13%

Carcinoma more than 1% .

That whole glands enlarged, darker in color. Firmer and more vascular .

Slide22

Clinical feature

Hyperparathyrodism rarely found in 1

st

decade of life's.

More common in women than men .

Most commonly between the age 20 -60 y

The disease has been described as : bones ,stones , abdominal groans and psychic moans

Slide23

Slide24

Parathormone increase

Bone disease

Renal stone

Psychic moans

Abdominal groans

Jonits, bones pain renal stone nausea ,vomiting, tiredness

density of bones nephroclcinosis anorexia personality change

Otitis fibrosa cystica renal colic peptic ulcer

Bone cyst (jaw bones) pancreatitis

Slide25

investigation

serum calcium upper limit (10.9 mg/dl)

serum phosphate lower limit (3 mg/dl)

excretion of ca in urine .

serum alkaline phosphatase .

serum PTH .

Slide26

Differential diagnosis

Secondary cancer in bones ( breast, prostate, bronchus, kidney, thyroid)

Carcinoma with endocrine secretion (bronchus , kidney, ovary)

Multiple myeloma

Vitamin d intoxication

Sarcoidosis

Thyrotoxicosis

Slide27

Slide28

treatment

Surgery is the only curative treatment

Pre operative treatment is not usually necessary.

Occasionally patient with hypercalcemic crisis need emergency treatment by fluids infusion and biphosphate therapy .

Slide29

Slide30

Slide31

Slide32

Slide33

Slide34

Slide35