Clinical Role of Ca, VitD, Exercise

Question 1

Effects of PTH on

1. Kidney
2. Bone

Answer 1

1. Ca reabsorption, phosphate excretion, conversion of 25 OH vitamin D to calcitriol
2. Bone resorption with sustained high PTH, bone formation with normal episodic release

Question 2

Cause of

1. Increased iPTH
2. Decreased or normal iPTH

Answer 2

1. Primary hyper PTH or familila hypercalcemic hypocalciuria

2. Malignancy

Question 3

Hyperparathyroidism clinical picture

Answer 3

Increased PTH
Longstanding asymptomatic hypercalcemia or milder hypercalcemia
Postmenopausal femal
Normal physical exam
Fam hx

Question 4

Malignancy clinical picture

Answer 4

Normal or decreased PTH
Higher level of serum Ca
More rapid increase in serum Ca
Therefore more symptomatic
Usually advanced disease (poor prognosis)

Question 5

Symptoms of hypercalcemia

Answer 5

Stones, bones, groans and psychic moans
Mild: no symptoms, or non specific such as constipation, fatigue, depression
Longstanding: renal stones polyuria, polydipsia, osteoporosis, fractures, bone pain, anorexia, abdo pain, constipation, decreased concentration, depression
Acute or rapid rise: stupor, coma, shortened QT

Question 6

4 causes of decreased Ca and decreased PTH

Answer 6

Surgical
Autoimmune
Congenital
Destruction or infiltration (rare)

Question 7

5 causes of decreased Ca with increased PTH

Answer 7

Vitamin D deficiency
CKD
Sepsis or severe illness
Postsurgical, hemorrhage
Osteoblastic metastasis (uncommon)

Question 8

Clinical manifestations of hypocalcemia (acute and chronic)

Answer 8

Acute: tetany, seizures
Cardio: decreased function, Qt prolongation, ventricular dysrhythmias
Chronic: dental changes, cataracts, extrapyramidal disorders

Question 9

Hypomagnesemia

Answer 9

Can reduce PTH secretion of cause PTH resistance
Malabsorption, longstanding diarrhea, chronic alcoholism, severe malnutrition
Remember to check and treat Mg if hypocalcemia is present

Question 10

When trying to determine VitaminD status, which form should you measure?

Answer 10

Serum 25(OH)D

Question 11

How much Ca should you be taking?

Answer 11

1200 mg is sufficient (total)

Question 12

Myostatin

Answer 12

Limits muscle tissue growth

If you are missing 1 or both copies you are really strong