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    9.calcium Homeostasis 125624

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    9.calcium Homeostasis 125624

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    jicowis226
    6 views18 pages

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    9.Calcium Homeostasis 125624

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    6 views18 pages

    9.calcium Homeostasis 125624

    Uploaded by

    jicowis226

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    © All Rights Reserved
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    Calcium and

    Phosphate
    Homeostasis
    Overview
    • Hypercalcemia
    • Hypocalcemia
    • Hyperparathyroidism
    • Hypoparathyroidism
    • Vitamin d deficiency
    • Renal Disease
    • Note on osteoporosis
    • Parathyroid hormone (PTH) plays a key role in the regulation of calcium and
    phosphate homeostasis and vitamin D metabolism.
    • The four parathyroid glands lie behind the lobes of the thyroid and weigh
    between 25 and 40 mg
    • When serum ionised calcium levels fall, PTH secretion rises.
    • PTH is a single-chain polypeptide of 84 amino acids. It acts on
    • the renal tubules to promote reabsorption of calcium and reduce reabsorption of
    phosphate,
    • and on the skeleton to increase osteoclastic bone resorption and bone formation.
    • PTH also promotes the conversion of 25-hydroxyvitamin D to the active metabolite,
    1,25-dihydroxyvitamin D; the 1,25-dihydroxyvitamin D, in turn, enhances calcium
    absorption from the gut.
    • Prolonged exposure of bone to high levels of PTH is associated with
    increased osteoclastic activity and new bone formation, but the net
    effect is to cause bone loss with mobilisation of calcium into the
    extracellular fluid. In contrast, pulsatile release of PTH causes net
    bone gain, an effect that is exploited therapeutically in the treatment
    of osteoporosis
    Hypercalcemia
    Symptoms and signs of
    hypercalcaemia
    • polyuria and polydipsia, renal colic, lethargy, anorexia, nausea,
    dyspepsia and peptic ulceration, constipation, depression, drowsiness
    and impaired cognition.
    • Patients with malignant hypercalcaemia can have a rapid onset of
    symptoms and may have clinical features that help to localise the
    tumour.
    • The classic symptoms of primary hyperparathyroidism are described
    by the adage ‘bones, stones and abdominal groans’, but few patients
    present in this way nowadays and the disorder is most often picked up
    as an incidental finding on biochemical testing.
    • About 50% of patients with primary hyperparathyroidism are
    asymptomatic
    • while others have non-specific symptoms such as fatigue, depression
    and generalised aches and pains. Some present with renal calculi and
    it has been estimated that 5% of first stone formers and 15% of
    recurrent stone formers have primary hyperparathyroidism.
    • Hypertension is a common feature of hyperparathyroidism. A family
    history of hypercalcaemia raises the possibility of FHH or MEN.
    • Parathyroid tumours are almost never palpable.
    Investigations
    • The differential diagnosis of disorders of calcium metabolism requires measurement of
    calcium phosphate, alkaline phosphatase, renal function, PTH and 25-hydroxyvitamin
    D.
    • Albumin correction
    • Inosied calcium

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