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PTH, Ca, Phosphate, Vit D

Parathyroid hormone (PTH) functions maintain blood Ca concentration
PTH actions increase Ca resorption from bone; increase Ca reabsorption from kidney; increase Ca absorption in intestines
PTH directly stimulates: bone (Ca and phosphorous resorption), kidney (production of calcitriol; Ca reabsorption; phosphorous excretion)
PTH indirectly (through the kidney) stimulates: bone resorption of Ca and phosphorous, intestinal absorption of Ca and phosphorous
Increased phosphorous causes _____ (increased or decreased) PTH: increased PTH
Increased Ca causes _____ (increased or decreased) PTH: decreased PTH
Decreased Ca causes _____ (increased or decreased) PTH: increased PTH
Decreased phosphorous causes _____ (increased or decreased) PTH: decreased PTH
Phosphorous and PTH have what kind of relationship? Direct relationship
Ca and PTH have what kind of relationship? Inverse relationship
Increased calcitriol causes _____ (increased or decreased) PTH: decreased PTH
Decreased calcitriol causes _____ (increased or decreased) PTH: increased PTH
Calcitriol = ? active vitamin D; 1,25-dihydroxy vitamin D
Calcitriol and PTH have what kind of relationship? inverse relationship
Parathyroid studies PTH, serum Ca, serum phosphorous
Primary hyperparathyroidism levels Inreased Ca; decreased-to-normal phosphorous; increased PTH
Secondary hyperparathyroidism normal Ca; increased phosphorous; increased PTH
Hypoparathyroidism decreased Ca; increased phosphorous; decreased PTH
Pseudohypoparathyroidism decreased Ca; increased phosphorous; increased PTH
Pseudohypoparathyroidism is a problem with: decreased tissue sensitivity to PTH (increased resistance to PTH)
Hypoparathyroidism is a problem with: deficiency of PTH
Hyperparathyroidism is a problem with: abnormally increased PTH
Secondary hyperparathyroidism is a problem with: renal insufficiency
Most common cause of hypercalcemia in ambulatory patients hyperparathyroidism
Most frequent patient population of hyperparathyroidism postmenopausal women
80% of hyperparathyroidism cases are due to: solitary parathyroid adenoma
18% of hyperparathyroidism cases are due to: hyperplasia of all 4 parathyroid glands
Primary hyperparathyroidism caused by one or more hyperfunctioning parathyroid glands that secrete excess PTH
Primary hyperparathyroidism causes increased Ca due to: increased bone resorption, increased kidney reabsorption, increased intestinal absorption
Primary hyperparathyroidism is caused by: adenoma, hyperplasia, carcinoma
Secondary hyperparathyroidism is caused by: pathological condition outside of the parathyroid glands, usually due to long-standing renal insufficiency
Secondary hyperparathyroidism leads to: chronic hypocalcemia (due to decreased renal reabsorption of Ca); increased PTH levels (trying to increase Ca levels); parathyroid gland hyperplasia (due to elevated PTH)
Hyperparathyroidism s/s stones, bones, abdominal groans, psychic moans, fatigue overtones
Most common presentation of hyperparathyroidism asymptomatic!
hyperparathyroidism diagnostic studies Ca (high in primary, normal in secondary); phosphorous (low-normal in primary, high in secondary); PTH (high in primary and secondary)
Hyperparathyroidism treatment primary (none, surgical excision); secondary (restrict dietary phosporous, phosphate-binding resins, vitamin D, calcitriol) - goal is raise serum Ca level
Hypoparathyroidism is caused by: 80% is caused by neck surgery (thyroid or parathyroid surgery); severe magnesium deficiency
Pseudohypoparathyroidism is caused by: increased target organ/tissue resistance to PTH
Hypoparathyroidism s/s s/s of hypocalcemia
Chvostek's sign involuntary twitching of the facial muscles initiated by light tapping of the facial nerve anterior to the auditory meatus
Trousseau's sign carpopedal spasm due to reduction in blood supply (BP cuff inflated for a few minutes above elbow)
Hypoparathyroidism diagnostic studies Ca (low in both); phosphorous (elevated in both); PTH (decreased in hypoparathyroidism, elevated in pseudohypoparathyroidism)
Hypoparathyroidism treatment acute (IV Ca, calcitriol); chronic (vitamin D, dietary Ca supplements)
Pseudohypoparathyroidism treatment vitamin D, dietary Ca supplements
Created by: Carrie D.