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ENDO I > PTH CIS > Flashcards

PTH CIS Flashcards

1
Q

What are symptoms of hypocalcemia

A

twitching, muscle cramps, tingling and numbness

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2
Q

what are symptoms of hypercalcemia

A

constipation, polyuria, polydipsia, lethargy, coma, death

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3
Q

how much calcium is usually bound to albumin

A

45%

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4
Q

What are PTH dependent hypercalcemic disorders

A

primary hyperparathyroidism
hypercalemia of malignancy
familial hypocalciuric hypercalemia

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5
Q

What are PTH independent hypercalcemic disorders

A 
thiazide diuretics
milk-alkali syndrome
immobilization
acture renal failure
granulomatous disease
VIT D or A intoxificiation
adrenal insufficiency
hyperthyroidism
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6
Q

What causes the hypercalcemia of malignancy

A

PTH RP

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7
Q

What is the key test in differential Dx of hypercalemia

A

serum PTH

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8
Q

What causes familial hypocalciuric hypercalcemia

A

heterozygous inactivation mutation in CaSR

increased PTH and serum Ca

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9
Q

What are the causes of hypocalcemia

A 
Vit D deficiency
hypoPTH
pseudohypoparathyroidism
hypomagnesemia
renal failure
liver failure
acute pancreatitis
hypoproteinemia
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10
Q

What causes hypoparathyroidism

A

usually autoimmune to parathyroid gland

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11
Q

describe pseudohypoparathyroidism

A

genetic disorder causing resistance to PTH

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12
Q

What is the key test in Dx for hypocalcemia

A

measurement of 25-OH VIT D

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13
Q

how does hypoproteinemia cause hypocalcemia

A

losing albumin, so cannot carry Ca

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14
Q

High Ca, low phosphate, extremely high PTH, normal albumin, elevated alkaline phosphatase, elevated urinary Ca excretion and calcium oxalate

A

hyperparathyroidism, tumor of parathyroid gland

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15
Q

What triggers alkaline phosphatase release

A

increased bone resorption from PTH levels

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16
Q

how will the levels of ionized Ca be if have alkalemia

A

decrease

H+ and Ca+ compete with eachother on albumin

17
Q

On what cell type in bone do PTH R sit on

A

osteoblasts

18
Q

what happens with PTH on bone resorption

A

bind R on osteoblasts
soluble mediators(cytokines)
stimulate osteoclasts
more Ca released from bone

19
Q

Why do people with primary PTH have increased alkaline phosphatase

A

increased bone resorption

triggers bone formation

20
Q

What is alkaline phosphatase a measurement for

A

bone formation

21
Q

What is the effect of increased PTH on kidney

A

increased production of 1,25 OH Vit D

22
Q

What are the 4 actions of PTH

A

increased bone turnover, increased intestinal Ca resorption due to increased 1,25 Vit D
decreased serum phosphate
increased renal Ca absorption

23
Q

What is significant of increased phosphate excretion on serum Ca levels

A

PTH action

24
Q

Why does someone with hyperparathyroidism have hypercalciuria

A

increased Ca resorption, kidney stones

25
Q

kidney stones presented with dehydration, what is the mechanism

A

increase in ADH secretion, concentration of urine

26
Q

pain with pressure applied to tibias is indicative of

A

Vit D deficiency

27
Q

What are the levels of Vit D deficiency

A

0-10 severe
10-20 moderate
20-30 mild
>30 normal

28
Q

a vit D deficiency leads to what bone disorder

A

osteomalacia

29
Q

bone problems associated with renal failure can be charcterized by what levels

A

a decrease in 1 alpha hydroxylase activity

30
Q

why do serum calcium levels not increase in bone problems due to renal failure

A

increase in phosphate leads to biding with Ca and can cause precipitation

31
Q

bone loss because of renal failure occurs because of what

A

renal phosphate clearance decreases in renal failure

32
Q

8 year old with muscle cramping of arms and legs and tingling of lips
Type I DM, addisons, hypothyroidism
low Ca, PTH, normal Vit D and albumin
increased phosphorous

A

hypoparathyroidism, autoimmune

33
Q

56 yr old hypercalcemic, asymptomatic except polyuria
increased Ca, low phosphorous, increased PTH, increased alkaline phosphatase and normal albumin
increased urinary cAMP elevated urinary cAMP and hydroxyproline
short QT
T score 2.0

A

primary hyperparathyroidism
overproduction PTH
T score shows she has osteoporosis
increased bone resorption

34
Q

When PTH is extremely high and Ca is slightly low what can be suspected

A

kidney failure

35
Q

If Ca is extremly high and PTH low/normal what can be suspected

A

High Ca of malignancy

36
Q

With very elevated PTH AND Ca what can be suspected

A

primary hyperparathyroidism

ENDO I (9 decks)

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