Term
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Definition
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Term
| About ___% of calcium is bound to proteins, primarily _________. |
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Definition
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|
Term
| What functions is calcium required in? |
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Definition
nerve conduction
muscle contraction
hormone release
blood coagulation |
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Term
| Calcium and __________ are intimately related. |
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Definition
|
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Term
| Where is the major pool of calcium found intracellularly? |
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Definition
|
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Term
| Where is the major pool of calcium found extracellularly? |
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Definition
| in blood bound to proteins |
|
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Term
| Where is the majority of calcium found? |
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Definition
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Term
| Only ___% of the calcium in bone is freely exchangeable with extracellular fluid. |
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Definition
|
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Term
| What 3 products work on keeping the balance of calcium in the body? |
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Definition
vitamin D (calcitrol)
calcitonin
PTH |
|
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Term
| What secretes calcitonin? |
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Definition
|
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Term
| How does calcitonin work? |
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Definition
stimulates osteoblasts to take calcium out of blood and form bone
inhibits mobilization of bone (and calcium) by osteoclasts |
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Term
| Where is the majority of phosphorus found? |
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Definition
| in bone (gives rigidity to bones and teeth) |
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Term
| The levels of calcium and phosphorus in blood are... |
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Definition
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Term
| Calcium and phosphate can chemically react to form ________. |
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Definition
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Term
| What is the most important endocrine regulator of calcium and phosphorus concentration in the extracellular fluid? |
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Definition
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Term
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Definition
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Term
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Definition
| when extracellular concentration of calcium falls to a low level |
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Term
| Phosphate is/is not a regulator of PTH. |
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Definition
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Term
| What organ plays a lesser role in calcium concentration? |
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Definition
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Term
| How many parathyroid glands do you have? |
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Definition
|
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Term
| Where are the parathyroid glands located? |
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Definition
| posterior surface of the thyroid |
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Term
| What type of receptors do the parathyroid glands have? |
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Definition
| calcium-sensing receptors |
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Term
| What nerve is very close to the parathyroid glands and should be a source of caution when operating? |
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Definition
| left recurrent laryngeal n. |
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Term
| What 3 organs are important in helping regulat calcium in the body? |
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Definition
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Term
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Definition
| break down bone and release calcium and phosphate into the bloodstream |
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Term
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Definition
| take calcium from the bloodstream and use it to build bone |
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Term
| Almost all of the calcium that is filtered through the _________ cells in the kidney is reabsorbed in the _________ cells and goes back into the bloodstream. |
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Definition
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Term
| What happens to calcium if the kidney is not functioning properly? |
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Definition
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Term
| Where is dietary calcium absorbed? |
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Definition
|
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Term
| How does PTH indirectly stimulate the small intestine? |
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Definition
targets the kidney to release active vitamin D (calcitrol)
induces synthesis of a calcium-binding protein in intestinal epithelial cells that absorbs calcium into bloodstream |
|
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Term
| What happens when there is a low blood concentration of calcium? |
|
Definition
1. release of PTH from parathyroid glands
2. efflux of calcium from bone (osteoclasts)
3. decreased loss of calcium in urine
4. active vitamin D release from kidneys
5. enhanced absorption of calcium from intestine
6. increased concentration of calcium in the blood |
|
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Term
| What happens when there is a high blood level of calcium? |
|
Definition
negative feedback with PTH
calcitonin released from thyroid |
|
|
Term
| Where is calcitonin made? |
|
Definition
| C-cells (parafollicular cells) in the thyroid |
|
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Term
|
Definition
lower blood calcium levels by inhibiting bone breakdown (osteoclasts)
opposes the effect of PTH |
|
|
Term
| Where is calcitonin's receptor primarily found? |
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Definition
|
|
Term
| What conditions can calcitonin be used to treat? |
|
Definition
hypercalcemia
osteoporosis |
|
|
Term
|
Definition
-decreased function of parathyroid glands
-decreased PTH
-decreased serum calcium (hypocalemia)
-rare |
|
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Term
| signs and symptoms of hypoparathyroidism |
|
Definition
-muscle cramps
-tingling sensations
-dry/brittle hair/skin/nails
-face, leg, foot pain
-cataracts
-poor tooth enamel
-tetany, seizures, decreased consciousness |
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|
Term
| Do you have problems with bone in a patient with hypoparathyroidism? |
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Definition
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Term
| Chronic hypoparathyroidism may only be evident with... |
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Definition
| visual changes (cataracts) |
|
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Term
|
Definition
| tapping on trigeminal n. elicits movement of mouth |
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Term
|
Definition
| inflating BP cuff on arm for a few min causes spastic flexion of wrist and fingers |
|
|
Term
| What lab findings are consistent with hypoparathyroidism? |
|
Definition
hypocalcemia
hyperphosphatemia
low PTH |
|
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Term
| What must be absent to diagnose hypoparathyroidism in the presence of hypocalcemia and low PTH? |
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Definition
| absence of kidney failure and intestinal malabsorption |
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Term
| What might an EKG on a patient with hypoparathyroidism show? |
|
Definition
prolonged QT interval
bradycardia
rarely ST segment elevations |
|
|
Term
| What vitamin deficiency can cause hypocalcemia? |
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Definition
|
|
Term
| What is the most common cause of hypoparathyroidism? |
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Definition
|
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Term
| What is the most common non-surgical cause of hypoparathyroidism? |
|
Definition
| autoimmune invasion and destruction |
|
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Term
| What iron disorder can cause hypoparathyroidism? |
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Definition
| hemochromatosis (iron accumulation) |
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|
Term
| What deficiency is common in alcoholics and can cause hypoparathyroidism? |
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Definition
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|
Term
| What physiologic process can cause hypoparathyroidism? |
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Definition
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Term
| treatment of hypoparathyroidism |
|
Definition
-get endocrinologist involved
-IV calcium in emergencies (calcium gluconate)
-long-term ttx: high calcium diet, calcium supplementation
-primarily treated with vitamin D (calcitrol) |
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|
Term
| What treatment is undergoing study for hypoparathyroidism? |
|
Definition
| teriparatide (synthetic form of PTH for osteoporosis) |
|
|
Term
| What complications are associated with hypoparathyroidism that occurs in childhood? |
|
Definition
stunted growth
mental retardation
malformed teeth |
|
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Term
| What risks does a patient have with hypoparathyroidism? |
|
Definition
pernicious anemia
cataracts
Addison's disease
Parkinson's disease |
|
|
Term
|
Definition
resistance to PTH
dysfunctional G proteins |
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Term
| What lab findings are consistent with pseudohypoparathyroidism? |
|
Definition
decreased serum calcium
increased serum phosphate
elevated PTH (due to hypocalcemia) |
|
|
Term
| What are the 3 types of pseudohypoparathyroidism? |
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Definition
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|
Term
| What type of pseudohypoparathyroidism is also known as Albright's hereditary osteodystrophy? |
|
Definition
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|
Term
| What clinical manifestations are associated with type 1a pseudohypoparathyroidism? |
|
Definition
short 4th and 5th metacarpals
rounded facies
short stature, obesity
developmental delay
calcification of basal ganglia
tetany, seizures
muscle cramps/spasms |
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|
Term
| What is type 1a pseudohypoparathyroidism associated with? |
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Definition
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|
Term
| inheritance of type 1a pseudohypoparathyroidism |
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Definition
|
|
Term
| type 1b pseudohypoparathyroidism |
|
Definition
lacks the physical appearance of type 1a
biochemically similar
associated with methylation defect |
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Term
| type 2 pseudohypoparathyroidism |
|
Definition
-lacks the physical appearance of type 1a
-normal cAMP response to PTH stimulation, but calcium regulation is abnormal
-genetic defect |
|
|
Term
| pseudopseudohypoparathyroidism |
|
Definition
pt. has phenotypic appearance of type 1a pseudohypoparathyroidism, but is biochemically normal
inherited disorder |
|
|
Term
| What condition is sometimes considered a variant of Albright's hereditary osteodystrophy? |
|
Definition
| pseudopseudohypoparathyroidism |
|
|
Term
| What does primary hyperparathyroidism result in? |
|
Definition
| excessive secretion of PTH by one or more parathyroid glands |
|
|
Term
| phosphate levels in primary hyperparathyroidism |
|
Definition
|
|
Term
| The incidence of primary hyperparathyroidism increases with... |
|
Definition
| age (highest in post-menopausal women) |
|
|
Term
| What is the most common cause of primary hyperparathyroidism? |
|
Definition
| parathyroid adenoma (90%) |
|
|
Term
| signs and symptoms of asymptomatic hyperparathyroidism |
|
Definition
usually a coincidental finding on labs
may have osteoporosis |
|
|
Term
| symptoms of symptomatic hyperparathyroidism |
|
Definition
neurological symptoms
weakness and fatigue
depression
BONE PAIN, myalgias
decreases appetite, n/v
constipation
polydipsia/polyuria
cognitive changes
nephrolithiasis |
|
|
Term
| What tests should be done to diagnose hyperparathyroidism? |
|
Definition
-serum calcium (elevated)
-serum PTH (elevated)
-bone density exam
-abdominal films to check for kidney stones |
|
|
Term
| treatment of primary hyperparathyroidism |
|
Definition
-surgical removal of one or more glands
-calcimimetics |
|
|
Term
| What complications are associated with surgery to correct hyperparathyroidism? |
|
Definition
-injury to nerves that affect speech
-chronic low calcium requiring calcium and vitamin D supplementation |
|
|
Term
| Hyperparathyroidism due to __________ has more complications associated with it that removal of an adenoma due to the extent of tissue involved. |
|
Definition
|
|
Term
| secondary hyperparathyroidism |
|
Definition
parathyroid glands overwork to compensate for long-standing hypocalcemia
causes parathyroid to release PTH to increase calcium (hypo- or normocalcemia may occur) |
|
|
Term
| What deficiency may cause secondary hyperparathyroidism? |
|
Definition
|
|
Term
| What drug can cause secondary hyperparathyroidism? |
|
Definition
|
|
Term
| tertiary hyperparathyroidism |
|
Definition
| parathyroid gland hyperplasia and loss of response to calcium serum levels |
|
|
Term
| What may tertiary hyperparathyroidism be due to? |
|
Definition
| long-standing secondary hyperparathyroidism |
|
|
Term
| What patients is tertiary hyperparathyroidism usually seen in? |
|
Definition
|
|
Term
| What lab findings are consistent with primary hyperparathyroidism? |
|
Definition
serum calcium high
PTH high |
|
|
Term
| What lab findings are consistent with secondary hyperparathyroidism? |
|
Definition
serum calcium normal or low
PTH high |
|
|
Term
| What lab findings are consistent with tertiary hyperparathyroidism? |
|
Definition
serum calcium high
PTH high |
|
|
Term
| How do you differentiate tertiary hyperparathyroidism from primary hyperparathyroidism since their lab findings are the same? |
|
Definition
| tertiary has history of secondary hyperparathyroidism and chronic kidney disease |
|
|
Term
| What is the most important step in caring for a patient with parathyroid disorders? |
|
Definition
| get endocrinologist involved |
|
|
Term
| Which organ involved in calcium balance in controlled indirectly by PTH? |
|
Definition
|
|
Term
| What protein is calcium most commonly bound to in the blood? |
|
Definition
|
|
Term
| Where is the majority of calcium found in the body? |
|
Definition
|
|
Term
| What is another name for vitamin D? |
|
Definition
|
|
Term
| How does vitamin D help regulate calcium balance? |
|
Definition
1. released from kidneys
2. induces synthesis of calcium-binding protein in intestinal epithelial cells that absorbs calcium into the blood |
|
|
Term
| What percentage of calcium is found in the bone? |
|
Definition
|
|
Term
| What do osteoblasts and osteoclasts do? |
|
Definition
osteoblasts--build bone
osteoclasts--break down bone |
|
|
Term
| TRUE/FALSE: There is a decrease in function in the parathyroid glands, increased levels of PTH, and decreased levels of calcium in hypoparathyroidism. |
|
Definition
|
|
Term
| What are Chvostek's and Trousseau's signs used for? |
|
Definition
|
|
Term
| What is the most severe complication associated with acute hypoparathyroid crisis? |
|
Definition
| airway obstruction (may need to be intubated) |
|
|
Term
| What is the most common cause of hypoparathyroidism? |
|
Definition
|
|
Term
| What treatment can you give for hypoparathyroidism in an emergency setting? |
|
Definition
|
|
Term
| What is type 1a pseudohypoparathyroidism also known as? |
|
Definition
| Albright's hereditary osteodystrophy |
|
|
Term
| What benign tumor do 90% of patients with hyperparathyroidism have? |
|
Definition
| benign parathyroid adenoma |
|
|
Term
| What might you see on an abdominal x-ray in someone with hyperparathyroidism and why? |
|
Definition
| kidney stones because of excess calcium |
|
|
Term
| TRUE/FALSE: There is increased function of the parathyroid glands, increased levels of calcium, and increased PTH in primary hyperparathyroidism. |
|
Definition
|
|
Term
| What is a treatment option for a patient with mild hyperparathyroidism? |
|
Definition
avoid high calcium foods
avoid immobilization
drink plenty of fluids |
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