Bones Flashcards
Hormones and locations?
PTH in parathyroid hormones and calcitonin in parafollicular cells. Calciitriol in skin + UV light.
Vit D by 25-hydroxylase in liver and 1alpha-hydroxlase in kidneys to activated form
Causes and features of primary HyperPTH?
Parathyroid adenoma or hyperplasia
Increased calcium and decreased phosphate
Secondary hyperPTH causes and features?
Called osteomalacia.
Vitamin D deficiency
CKD
Liver disease
Decreased calcium and phosphate (if Vit d deficient). Increased phosphate (if CKD)
Tertiary hyperPTH causes and features?
CKD (causes autonomous PTH secretion)
Increased calcium and increased phosphate
Causes of high caclium?
High PTH: primary and tertiary hyperPTH
Low PTH:
1) Malignancy (bone mets, Haem e.g multiple myeoma, paraneoplastic e.g. lung SqCC
2) Sarcoidosis
3) Thiazide diuretics
Pancreatitis
Causes of low Calcium?
Secondary hyperPTH
Surgical complication
Auto-immune hypoparathyoridism
Signs for low calcium?
Trousseas and Chvosteks
Primary hyperPTH RFs and signs/symptoms?
MEN-1/2, hypertension
Often asymptomatic
hypercalcaemia features
Hypercalcaemia features?
Stones, bones, thronoes, abdo moans and psych groans
Men-1 conditions?
Pituitary tumours + pancreatic tumours + PTH gland hyperplasia
Men2 conditions?
Phaeochromocytomas + medullary thyroid cancer + PTH gland hyperplasia
Seconcary HyperPTH signs and symptoms?
fractures/bone pain, proximal myopathy, fatigue, hypocalcaemia
CATs go numb.
Rickets : Bowed Legs
Knock knees
Proximal myopathy endocrine causes?
COT
Cushings
Osteomalacia
throtoxicosis
Causes of Secondary HyperPTH?
Vitamin D deficiency (poor diet, sunlight and malabsorption)
CKD
Liver Disease
ALP differences?
Same in primary hyperPTH and raised in secondary/osteomalacia
Primary HyperPTH Xray features?
Subperiosteal bone resorption (radial)
Acro-osetolysis
pepper pot skull
Secondary hyperPTH xray features?
Rachitic Rosary (nodularity at costochondral junctions) Loosers pseudofractures
Primary HyperPTH management?
Acute hypercalcaemia : IV fluids and bisphosphonates
Surgical: 1st line = total parathyroidectomy
If surgery unsuitable = cinacalcet (calcimimetic)
Risk of parathyroidectomy?
Damage to recurrent laryngeal nerve and speaking
osteomalacia management?
Acute hypocalcaemia: IV calcium infusion (calcium glucoronate )
medical = calcium and vit D (ergocalciferol Inactive)
If due to CKD: calcium, alfacalidol (active) and treat CKD
What else is calcium gluconate used to treat>
Hyperkalaemia
What is Pagets disease and phases?
Disorder of bone remodelling
1) Lytic phase (hyperactive osteoclasts)
2) mixed phase (compensation from osteoblasts)
3) Sclerotic phase (hyperactive osteoblasts = woven bone, not lamellar)
RFs for Pagets?
Elderly and RHx
Symptoms and signs of Pagets?
Symptoms: often asymptomatic, fragility fractures, bone pain (skull, pelvis, femur), nerve compression (hearing loss and sciatica)
Signs = bone enlargment and bossing, warm skin over the painful area (metabolic)
Investigations for Pagets?
Normal calcium, phosphate, PTH.
High ALP
Look at serum CTX (resorption) and Serum P1NP (formation markers) Bone Scan (tec99)
Causes of osetoporosis?
Primary = post-menopausal and elderly
Secondary - Drugs ( steroids, thyroxine, alcohol), Endo (cushings, HyperPTH, Hyperthyroid), GI = coeliac and IBD
Signs and symptoms of osteoporosis?
Often asymptomatic
Fragility fractures
Back pain
Common osteoporotic fractres?
HIP - NOF
Wrist - Colles fracures
Lumbar - wedge fractures
Shoulder - NOH
Osteoporosis Bloods and Imaging?
Calcium, phosphate, PTH and ALP all normal
USe DEXA T score < -2.5
Signs of hypocalcaemia?
CATs go numb Convulsions Arrhythmias Tetany Parasthesia in hands,feet, mouth
