57.3 🩺 內科專科考前版

57.3.0.1 📌 䞀頁重點

  • 22E: SGLT2i + bisphosphonate + denosumab roles
  • 1° HPT diagnostic criteria 曎新
  • Taiwan: lithium-induced hyperCa, MEN-1/2 monitoring

57.3.0.2 💊 進階

57.3.0.2.1 Primary HPT Surgery Indications
  • Symptoms (stone, bone, etc.)
  • Asymptomatic with:
    • Age < 50
    • Ca > 1 mg/dL above ULN
    • Bone density T-score ≀ -2.5
    • Vertebral fracture
    • Renal stone / nephrocalcinosis
    • GFR < 60
    • Urine Ca > 400
57.3.0.2.2 Cinacalcet (Calcimimetic)
  • Activates CaSR → ↓ PTH
  • For 2°/3° HPT (CKD), parathyroid carcinoma, refractory 1° HPT
  • Side: GI, hypoCa
57.3.0.2.3 Etelcalcetide
  • IV calcimimetic for HD patients
57.3.0.2.4 MEN Syndromes
  • MEN-1: Pituitary, Parathyroid, Pancreas
  • MEN-2A: Medullary thyroid, Pheochromocytoma, Parathyroid
  • MEN-2B: Medullary thyroid, Pheo, Mucosal neuroma
57.3.0.2.5 Pseudohypoparathyroidism (PHP)
  • Type 1A (Albright): GNAS mutation, Albright osteodystrophy
  • End-organ PTH resistance
  • High PTH but low Ca
57.3.0.2.6 Hungry Bone Syndrome
  • Post-parathyroidectomy in severe HPT
  • Severe hypoCa, hypoP, hypoMg
  • Aggressive replacement

57.3.0.3 🌟 Pearls (10)

  1. Always measure ionized Ca in critical care (not total)
  2. PTH-suppressed hyperCa → workup malignancy + granulomatous + vit D
  3. FHH distinguishes from 1° HPT by urine Ca/Cr clearance ratio
  4. Lithium: shifts CaSR setpoint
  5. Cinacalcet for parathyroid carcinoma + 3° HPT
  6. Bisphosphonate ONJ prevention with dental clearance
  7. Denosumab discontinuation rebound osteoclast activity
  8. Hungry bone syndrome = aggressive replacement
  9. Pseudohypoparathyroidism = end-organ resistance
  10. Vit D toxicity from supplements rising

57.3.0.4 📍 Taiwan Context

  • 健保 bisphosphonate / denosumab
  • Cinacalcet for HD with 2°/3° HPT
  • Parathyroidectomy 普及

57.3.0.5 🎓 內專重點

  1. PTH-dependent vs suppressed
  2. 1° HPT surgery indications
  3. Bisphosphonate / denosumab / cinacalcet
  4. MEN syndromes
  5. Pseudohypoparathyroidism
  6. Hungry bone

⚠ AI 草皿。