USMLE Step 1 Web Prep — Hormonal Control of Calcium and Phosphate: Part 2

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PRIMARY PATHOLOGICAL CHANGES IN PTH SECRETION
Signs of Primary Hyperpara !yroi"ism (tumor) Initiating factor is hypersecretion of PTH onse!uences • Increase" p#asma ca#cium ($one resorption% rea$sor$ a in "ista# tu$u#e) • &ecrease" p#asma phosphate ($one resorption' raise p#asma P% $ut "amp P in the urine in pro(ima# tu$u#e) Signs of Primary Hypopara !yroi"ism Initiating factor is ina"e!uate secretion of PTH It is cause" $y !yroi" s#rgery onse!uences • &ecrease" p#asma a)) • Increase" p#asma phosphate • Tetany (uncontro##a$#e muscu#ar contractions)' hypo aemia (not "irect#y affect s*e#eta# musc#e% increases e(cita$i#ity of neuron) + tap facia# ner,e' e(cite" P#asma ca#cium an" phosphate changing in opposi e "irection is usua##y a primary "isor"er -n e(ception you may encounter is $!roni$ rena% fai%#re + not a primary "isor"er% hypor aemia% hypoPemia
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SECONDARY PHYSIOLOGICAL AND PATHOLOGICAL CHANGES IN PTH SECRETION
The on#y physio#ogica##y significant signa# affecting PTH secretion is free ca#cium Se$on"ary parathyroi"ism can $e pre"icte" from e(pecte" changes in circu#ating Ca'
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Se$on"ary !yperpara !yroi"ism ause - "ecrease in p#asma a)) .hich e#icits an increases in PTH secretion /g0 - "iet "efi$ien in (i amin D (not a$sor$ a form sma## intestine' "ecrease p#asma a) 1ummary • Increase" p#asma PTH • &ecrease" p#asma a)) • &ecrease" a)) e(cretion • &ecrease in p#asma phosphate ("amp P in urine)
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Se$on"ary !ypopara !yroi"ism

circulation form of D (measured clinically).n' increase PTH' 2one resorp ion (P#asma a is o.hich e#icits a "ecreases in PTH secretion /g0 -n e*$essi(e inta*e of (i amin D ( more a a$sor$ form sma## intestine' raise p#asma a) 1ummary • &ecrease" p#asma PTH • Increase" p#asma a)) • Increase" a)) e(cretion • Increase in p#asma phosphate (#ess P goes in urine) 3hen the p#asma ca#cium an" phosphate are changing in !e same "irection the origin is usua##y a secon"ary "isor"er + secon"ary hyperparathyroi"ism + $oth "ecrease – secon"ary hypoparathyroi"ism + $oth increase p#asma a an" P + in opposite 'primary (e(cept chronic rena# fai#ure)% in the same' secon"ary 152995 >>> 0:14:14 SLIDE + of 5 ROLE O.acti#ates D – 2 !"-D to () 2 -di!"-D3 – hormonal D3 (-a-hydro&ylase is acti#ated 'y lo$ %lasma * and 'y *+" (%ro&imal tu'ule) 152000 >>> 0:22:25 SLIDE 5 of 5 A$ ions of 11&5 "i OH D) 6n"er norma% con"itions 7itamin & acts to raise p#asma a)) an" phosphate 7itamin & promotes 2one "eposi ion ( aP> so#0 pro"uct) -ctions • 1%25 "i 8H &2 increases the a$sorption of a)) an" phosphate $y the sma%% in es ine • 1%25 "i 8H &2 increases the rea$sorption of a)) $y rena# "ista# tu$u#e (faci#itate PTH) • -t !ig! a$ i(i y #e.2 !" D.no acti#ity) Kidney (%ro&imal tu'ule.(a.to the liver. -ITAMIN D) .CHOLECALCI.has #ery lo$ acti#ity (%hysiologically.ause -n increase in p#asma a)) .EROL/ IN CALCI0M HOMEOSTASIS 2 sources: dietary D3 synthesized D3 in skin under UV light (daily minimal requirement if enough sunlight) D3.er $one a) Effe$ s of 11&5 "i OH D) e*$ess on 2one3 .e#s 1%25 "i 8H &2 increases the resorption of a)) an" phosphate from $one (superphysio#ogica##y)' not norma##y Effe$ s of 11&5 "i OH D) "efi$ien$y on 2one3 1econ"ary hyperparathyroi"ism + "eficient & ' nor a$sor$ a in the sma## intestine% p#asma a goes "o.hydro&ylase).

itamin & pro"uces ina"e!uate $one minera#i./(cess .ation .itamin & acts "irect#y on $one an" pro"uces e(cess 2one resorp ion #ea"ing to osteoporosis 9:ote that either a "eficiency or an e(cess of .