Hyperparathyroidism

Question 1

What is parathyroid hormone (PTH)?

Answer 1

Hormones that aids in ca and phos homeostasis
When PTH is released from parathyroid gland, it causes bone RESORPTION, increasing calcium
HIGH PTH = HIGH Calcium levels and lower PHOS levels
LOW PTH = HIGH PHOS, low CA
Hyperparathyroidism increases osteoporosis risk, kidney : more PTH, more bone resorption, more brittle bones and more free calcium inc risk for kidney stones

Question 2

How does kidney failure lead to HYPERparathyroidism?

Answer 2

Kidney fails > inability to convert vit D to most active form
> drop in calcium > drop in Ca stimulates PTH production

Question 3

What is one reason why Ca homeostasis is important?

Answer 3

Elevated serum Ca can contribute to increase cardiovascular risks

Question 4

What are the organizations that cover targets for hyperparathyroidism and kidney disease?

Answer 4

KDIGO, KDOQI

Question 5

If ca and phos homeostasis is not maintained, there is risk for ca and pho deposits in the kidney which can lead to kidney disease. T/F?

Answer 5

True

Question 6

What are common risk factors for HYPERparathyroidism?

Answer 6

Females
Lithium use

Question 7

What medications are used for HYPERparathyroidism?

Answer 7

Calcimimetics: Cinacalcet: mimics Ca in negative feedback loop (Higher Ca will need to reduced PTH, thus less bone resorption)
*important to monitor Ca and phos levels
*side effects: low BP, paresthesia’s, fatigue, GI, anemia
*3A4 inhibitors may inc concentration

Vitamin D analogs: cholecalciferol, ergocalciferol, calcitriol: Need for absorption of Ca thus inc Ca levels and decreasing PTH
*Vitamin D analogs alone not likely to reduce PTH on its own

Bisphosphonates: can help reduce loss of Ca out of bones, protection of osteoporosis

Phosphate binders