USMLE Step 1 Web Prep — Hormonal Control of Calcium and Phosphate: Part 1

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Chapter 8: Hormonal Control of Calcium and Phosphate
CALCIU C! PA"# E$#S !% #HE &!D' Most Ca- in bone (99%) is in equilibrium with interstitial flui (free unboun free Ca- bioa!ti"e Ca)# whi!h is in equilibrium with $lasma Ca (half- free a!ti"e Ca# halfboun to $rotein# not a!ti"e) %ree Ca- re&ulate $re!isel'- equal in interstitium an $lasma (1(5 mM) )s- *f $t+s total Ca $lasma- lower than ,# no sin&s of h'$oCaemia( -ou shoul measure total $lasma $rotein( if $rotein - ele"ate # total Ca- ele"ate if $rotein . own# total Ca- own# but free Ca is not own or u$
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"ELA#I!$SHIPS &E#)EE$ CALCIU

A$D PH!SPHA#E

0hether !al!ium an $hos$hate are lai own in bone ($re!i$itate from solution) or are resorbe from bone (Ca124 &o into solution) e$en s u$on the $ro u!t of their !on!entrations rather than their in i"i ual !on!entrations( 0hen the $ro u!t e3!ee s a !ertain number (solubilit' $ro u!t or ion $ro u!t)# bone is lai own( 4Ca556 3 41246 > solubilit' $ro u!t 7 bone e$osition infusion 1 in i"i ual# then 1 in!rease- si&nifi!antl'# then Ca81 > sol $ro 7 $re!i$it form sol 7 free $lasma Ca e!rease h'$er1emia- 9'$oCaemia 0hen the $ro u!t is below the solubilit' $ro u!t# bone is resorbe 4Ca556 3 41246 : solubilit' $ro u!t 7 bone resor$tion ;i ne' is am$in& si&nifi!ant 124 in urine7 low $lasma 1247 Ca8124: sol( $ro 7 Ca124in the solution- raise free Ca $lasma 0hat is re&ulate so $re!isel' is free Ca55# not $hos$hate# an hormonal !ontrol of free Ca55 is almost entirel' "ia parath*roid hormone <'stem allow $hos$hate to !han&e in or er to re&ulate free Ca
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PA"A#H'"!ID H!" !$E ,P#H=elease from the $arath'roi s in res$onse to lowere interstitial free Ca 55 In fact the onl* important ph*siolo.ical si.nal re.ulatin. release of P#H is free Ca//

fun!tional unit( =esorb. 1@9 . $romote bone resorb) • *n!reases the e3!han&e of !al!ium from interstitial flui $ool surroun in& bone (Ca from the solution to the &eneral interstitium) Bone !ells • 2steoblasts ( e$osit bone) arise from osteo$ro&enitor !ells of mesen!h'mal ori&in • 2steo!'tes are osteoblasts whi!h be!ome entra$$e in mineraliCe bone • 2steo!lasts (resorb bone) arise from mono!'tes whi!h mi&rate to bone Blast an !last .osteoblasts.both a!ti"ate @he re!e$tors for $arath'roi hormone are a!tuall' on the osteo3lasts# not the osteo!lasts( 1@9.%un!tion is to raise free Ca55 whi!h it oes so b' se"eral me!hanisms 1529>0 >>> 0:1?:10 SLIDE 0 of 7 Actions of parath*roid hormone that raise free Ca // %ast a!tions of 1@9 • *n!reases Ca55 reabsor$tion in the istal tubule of the 1idne* • Ae!reases $hos$hate reabsor$tion in the pro2imal tubule ( e!rease Ca1 .si&nal to osteo!lasts.%i.=e!e$tor.1@9 a!tion( 1lasma Ca> bone !a( 'ou+re alwa's resorb bone mass in or er to maintain $lasma Ca (e"en 50% or more of bone is resorbe ) 1529>5 >>> 0:20:09 SLIDE 4 of 7 Calcitonin 5 minor hormone • • • • Cal!itonin is a $e$ti e hormone se!rete b' the $arafolli!ular !ells (ECF !ells) of the th'roi (C !ells mi&rate to th'roi # so Cal!itonin not a th'roi hormone) *s release in res$onse to ele6ated free !al!ium Dowers $lasma !al!ium b' e!reasin& the a!ti"it' of osteo!lasts# thus e!reasin& bone resor$tion (osteoclasts has re!e$tors for calcitonin) Cal!itonin is not a maGor !ontroller of Ca55 in humans (if 'ou lose !al!itonin .both a!ti"ate # e$ositin&.resor$tion <lower a!tions of 1@9 • 1@9 slowl' in!reases the formation an a!ti"it' of osteo!lasts whi!h resorb bone Ca55 • 1@9 in!reases the formation of 1#25 i 29 A ? (a!ti"e "it( A) in the $ro3imal tubules (a!ti"ate 1-a-h' ro3'lase) Don&term $roblem.ure I7 880-9 *f $lasma Ca: 10 m&H l . no si&nifi!ant in $lasma Ca) Summar* of the Effects of Plasma Ca// on P#H and Calcitonin Secretion .

@he absen!e of wei&ht-bearin& stress $romotes the emineraliCation of bone • 1lasma Ca55 ten s to be in the u$$er re&ion of normal • 1lasma 1@9 e!reases • Jrinar' !al!ium in!reases *n i!es !an be utiliCe to ete!t e3!ess bone emineraliCation an remo elin&: • *n!rease serum al. own $ro u!t of !olla&en (osteo!lasts) .aline $hos$hatase# an enC'me asso!iate with osteoblasti! a!ti"it' • *n!rease urinar' e3!retion of h' ro3'$roline# a brea.resorb bone 2( 2steoblasts.mineraliCation ..e$osit bone 1529/5 >>> 0:2>:0I SLIDE 7 of 7 &!$E "E !DELI$. Cal!itonin 1529/0 >>> 0:24:0? SLIDE : of 7 %U$C#I!$ !% &!$E CELLS I$ #HE "E !DELI$. @hou&h $oorl' un erstoo # wei&ht-bearin& stress in!reases the mineraliCation of bone *f 'ou lie.lose bone mass *f 'ou wal.lose Ca in urine.'ou loss bone mass. !% &!$E • • • Bone is un er&oin& !ontinual remo elin& throu&hout life @urno"er is faster in 'oun&er in i"i uals More remo elin& o!!urs in lo< densit* bone than in !om$a!t or hi&h ensit' bone 2 ste$s in bone remo elin&: 1( 2steo!lasts.*f $lasma Ca> 10 m&H l .&ra"it' effe!t.