Term
| how do you calculate corrected Calcium? |
|
Definition
| Measured Ca + (0.8)(4-serum albumin) |
|
|
Term
| What is the major regulator of PTH secretion? |
|
Definition
| Ionic Calcium concentration |
|
|
Term
| What are the effects of PTH on the bone? Kidney? GI Tract? |
|
Definition
BONE: increased resorption of Ca and PO4
KIDNEY: increased tubular resorption of of Ca, increased PO4 and HCO3 secretion, stimulates renal 1a-hydroxylase to convert vitamin D-->active vitamin D
INTESTINE: increased absorption of C via vitamin D |
|
|
Term
| what is the active form of vitamin D and where is it synthesized? |
|
Definition
1,25(OH)2D3 (calcitriol)
synthesized in the kidney |
|
|
Term
| what cells release calcitonin? |
|
Definition
|
|
Term
| what are some parathyroid hormone-independent causes of hypercalcemia? |
|
Definition
adrenal insufficiency
hyperthyroidism
milk-alkali syndrome
estrogen, thiazide diuretics |
|
|
Term
| what are the symptoms of hypercalcemia |
|
Definition
dehydration (large osmo load in serum)
weight loss
anorexia
constipation
slows down neuromuscular system (fatigue lethargy, wekness, hyporeflexia)
confusion
seizures
coma
itching (pruritis)
polydipsia |
|
|
Term
| malignancy can cause..(cancer) |
|
Definition
|
|
Term
| chronic hypercalcemia has a characteristic ____ |
|
Definition
| band or limbus keratopathy (at 3-9 o'clock) |
|
|
Term
| primary hyperparathyroidism-solitary adenoma |
|
Definition
| 80%, remeaning glands suppressed |
|
|
Term
| primary hyperparathyroidism hyperplasia |
|
Definition
| all four glands enlarged (18%) |
|
|
Term
| "salt-and-pepper" skull is indicative of what? |
|
Definition
|
|
Term
| what is the phosphate levels in primary hyperparathyroidism? |
|
Definition
|
|
Term
| secondary hyperparathyroidism |
|
Definition
| a marked increase in PTH because of long-standing renal failure (decreased reabsorption, chronic PO4 retention, decreased vitamin d synthesis) |
|
|
Term
| tertiary hyperparathyroidism |
|
Definition
| autonomous PTH hypersecretion after years of prolonged hypocalcemia which eventually cause hypercalcemia |
|
|
Term
| humoral hypercalcemia of malignancy (HHM) |
|
Definition
| most common paraneoplastic syndrome, caused by PTH-related peptide (not caused by native PTH secretion) |
|
|
Term
| Humoral hypercalcemia of malignancy is common in what type of carcinoma? |
|
Definition
| breat carcinoma with extensive bony metastases, squamous cell lung carcinoma |
|
|
Term
| lymphoma causes hypercalcemia by |
|
Definition
| ectopic production of calcitriol |
|
|
Term
| multiple myeloma causes hypercalcemia by |
|
Definition
|
|
Term
| what is the treatment of vitamin D-dependent hypercalcemia |
|
Definition
| withdrawal of medication, glucocorticoid administration |
|
|
Term
| metabolic alkolosis has what effect on calcium? |
|
Definition
| hypocalciuria leading to hypercalcemia |
|
|
Term
| adrenal insufficiency causes what in regards to calcium levels in body |
|
Definition
| up-regulation of vitamin D-mediated Ca receptors in gut, leading to increased absorption |
|
|
Term
| what causes an increase in both calcium and po4 |
|
Definition
| vitamin D-dependent hypercalcemia |
|
|
Term
| what is the treatment of hypercalcemic crisis? |
|
Definition
first IV fluids, then give furosemide (loop diuretic)
glucocorticoids (for vit D dependent hypercalcemia)
bisphophonates (bind irreversibly to osteoclasts to prevent reabsorption) |
|
|
Term
| what are the signs and symptoms of hypopcalcemia? |
|
Definition
twithcing, seizures, hyperreflexia, trousseau's sign
prolonged qt, GI malabsorption, cataracts |
|
|
Term
| what is the most common cause of hypoparathyroidism? |
|
Definition
|
|
Term
| A deficiency in this cation can cause hypoparathyroidism |
|
Definition
|
|
Term
| how do you treat hypoparathyroidism |
|
Definition
|
|
Term
|
Definition
| target tissue resistance to PTH producing clinical symptoms of hypoparathyroidism with elevated PTH levels |
|
|
Term
| what are the clinical features of psuedohypoparathyrodisism? |
|
Definition
| short stature, obestity (SHORT 4th METACAPRALs) mental retardation |
|
|
Term
| pseudopsuedohypoparathyroidism |
|
Definition
| classic somatic anomalies of PHP but without biochemical manifestations (CA normal) and cannot do anything about it |
|
|
Term
CA, PO4, PTH levels of:
1 hypoparathyroidism
2. psuedohypoparathyroidism
3. vit d deficiency |
|
Definition
1. low calcium, high phosphate, low PTH
2. low calcium, high phosphate, high PTH
3. low calcium, low phosphate, high PTH |
|
|
Term
| what are some of the risk factors for osteoporosis? |
|
Definition
| norhtern caucasian, asian race, small bone mass, hypogonadism, cigarette smoking, immobilization, |
|
|
Term
| what is the most common cause of osteoporosis? |
|
Definition
| estrogen deficiency, but estrogen causes an increase risk of coronary and thromboembolic disease so be careful giving estrogen to older woman |
|
|
Term
| An excess of glucoccorticoid (such as chronic use of steroids) can cause..... |
|
Definition
|
|
Term
| What scan is used for diagnosing osteoporosis? What is a T- score? |
|
Definition
DEXA
2.5 s.d below mean for young adult =t score=osteoporosis
1 to 2.5 s.d. t score =osteopenia |
|
|
Term
| what are some treatment options for osteoporosis? |
|
Definition
| estrogen, androgen, bisphophonates (stimulate born formation by binding up osteoclasts) |
|
|
Term
|
Definition
Ricketts in children
failure of normal mineralization
vit d deficiency, malabsorption, renal disease, phophate deficiency, drugs, tumor-associated |
|
|
Term
| osteomalacia patients have what levels of calcium and phosphate in their blood? |
|
Definition
|
|
Term
|
Definition
| disorganized mosaic of bone because of bone remodeling/mineralization unbalance |
|
|
Term
| what is the common complaint with paget's patients? What kind of CN abnormalities can occur? |
|
Definition
headache
CN palslies b/c of compression (i.e. hearing loss0 |
|
|
Term
| A patient with pagets presnts with severe pain. You are concerned he may have developed a ______. |
|
Definition
| osteosarcoma (more common in paget's patients but still less than 1% chance of getting) |
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