calcium lecture 3

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  • Created by: emma
  • Created on: 11-12-13 23:01
What is primary hyperparathyroism caused by?
monoclonal parathyroid adenoma
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What does primary hyperparathyroidism cause?
hypercalcaemia, hypophosphatamia, bone demineralisation, hypercalciuria --> kidney stones and bone cysts
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what may cause adenomas?
Mutation of the vitamin D receptor gene or multiple endocrine neoplasia tumor suppressor gene. also over expression of cyclin D1 (cell regulator)
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stones,, bones...
abdominal groans and psychic moans
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Treatment of primary hyperparathyroidism?
parathyroidectamy. inexpensive, curative, need long term medical follow up. need calcium and vit D replacement for life.
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what is the main cmplication of parathyroidectamy?
nephrolithiasis --> hydration and moderate calcium intake
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minimally invasive radioguided parathyroidectamy..
less invasive and use local anasthetic. 1. techetium99 labelled protein selevtively labels parathyroid. normal glands label poorly due to calcium induced inactivity. 2. pre-operative scan -> localisation of gland. 3. tissue labelled and removed
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What are the names of the channels that move sodium potassium and hydrogen in and out of the cells in secondary HPT
NaPi and NHE
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what does secondary hyperparathyroidism cause
hyper[hosphataemia and hypocalcaemia. in chronic renal failure, kidney fails to excrete sufficient phsophates.
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Vit D in treatment of secondary HPT
No reversal of parathyroid hyperplasia. Increased serum calcium and phosphates. Slow onset of decreased PTH secretion
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calcimimetics to treat secondary HPT
cinacalcet (I dose daily) - rapid reduction in PTH secretion. stably decreased after 3 years. like a chemical parathyroidectamy.
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combined calcimimetics and vit D
potentiation of decreased PTH levels. Vitamin D supports calcium levels
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secondary parathyroidism phosphate binders
bind phosphate in GI insoluble compound with meals. Renagel controls hyperphosphatemia in adult dialysis patients. weak effect on decreasing PTH, conjugate with vitD. Calcichew, titralac and phosex increase blood Ca
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other pathoendocrine causes of hypercalcaemia
humoral hypercalcaemia of malignancy, chronic lithium treatment for bipolar, thyrotoxicosis/graves, vit D intoxication, adrenal insufficiency
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hypoparathyroidism
inadequate PTH secretion, hypocalcaemia and hyperphosphataemia
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hypoparathyroidism causes
congenital: DiGeorge, Kenny-Caffey and Barakat syndromes. Immune destruction of parathyroid glands. ADH(CaR mutation), neck surgery.
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hypoparathyroidism symptoms
weakness muscle cramps, sensations in hand, memory loss, headaches, nerves, cramps in wrists and feet, malformed teeth and finger nails, anaemia, alopcia, vitalgo, trousseaus sign and chvostek sign
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pseudo-hypopoarathyroidism type Ia
Common form. mutation in GNASi (encodes Gsalpha). 50% decrease in activity. imparied cAMP
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pseudo-hypopoarathyroidism type Ib
rare. hypocalcaemia and hyperphosphataemia due to resistance to PTH. cAMP defect in phsphaturic effect.
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vitamin D dependent rickets type I
inactivating mutation in I alpha OHase gene in VDDRI patients proximal tubule
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Osteoporosis
bone mineral density under 2.5 SD below control. osteoporotic bone loss, imbalance of modelling - increased resorption and decreased formation. fracture proximal femur, vertebrae, forearm, pelvis and humerus
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oestrogen deficiency
increased bone turnover, increased resorption phase and decredased formation (increased osteoblast apoptosis). oestriol post menopausal females 20-3yrs: 338 and 70-80yrs: 78.
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how many people in the UK have osteoporosis?
3 million. 1/3 women and 1/12 men. costs nhs 1.7 billion a year
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what is bone health determined by?
pedak bone mass and rate of bone loss with age
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what do oestrogens do?
maintain bone mass density and skeleton structure in women. bind osteoblstic estrogen receptors. In men also role.
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what are the treatments for post menopausal osteoporosis?
bisphosphonates - alendronate, risedronate, etidronate decrease fracture risk. inhibit osteoclasts. heart burn, upright 30 min after drug. stroneum ranelate - anabolic. raloxifene - oral selective estrogen R modulator. Teriparatide post frac
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What does primary hyperparathyroidism cause?

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hypercalcaemia, hypophosphatamia, bone demineralisation, hypercalciuria --> kidney stones and bone cysts

Card 3

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what may cause adenomas?

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Card 4

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stones,, bones...

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Card 5

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Treatment of primary hyperparathyroidism?

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