CLINICAL CHEMISTRY III

PARATHYROID GLAND

Chapter 6: The Parathyroid Gland

PARATHYROID GLAND

-are small glands of the endocrine system which are

located in the neck behind the thyroid.
-there are four parathyroid glands which are normally
the size and shape of a grain of rice.
-occasionally they can be as large as a pea and still be
normal.

Calcium Homeostasis

-Calcium enters and leaves the blood pool.

-Calcium is the centric commodity in calcium
homeostasis.
-Principal organs involved in this flux are the small intestine, the skeleton (bone), and the
QWkidneys
-All calcium that enters the body after birth arrives via GI absorption.
-Dietary Calcium, therefore, plays a crucial role in Calcium homeostasis as the only “outside”
source of calcium to the body.
-Bone, the chief reservoir of calcium in the body, can serve to remove calcium from the body to be
stored in bone and release calcium stored in bone to the blood.
-The real net loss of calcium from the body occurs via the kidneys in urine.

Dietary Calcium BONE

Organ Physiology
The Only “In”
Endocrine Physiology
↓ ↓↑
↓ ↓↑
↓ Dietary Habits, Blood Calcium
↓ Supplements ↓↑
↓ ↓↑
Intestinal Absorption Kidneys
Organ Physiology Organ Physiology
Endocrine Physiology Endocrine Physiology

Urine
The Principal “Out”

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PARATHYROID GLAND

HORMONE CONTROL OF CALCIUM METABOLISM

2 hormones play the dominant role in the endocrine regulation of Calcium homeostasis:
1. Parathyroid Hormone
2. Vitamin D

PARATHYROID HORMONE (PTH)

-Physiologically, PTH preserves blood calcium and phosphate in the normal range.

-Acts primarily to raise blood calcium (low blood calcium is the primary signal to the parathyroids to affect
this response.)

-Acts on BONE (to cause bone resorption and increase blood calcium) and the KIDNEYS (to increase
fractional reabsorption of renal tubular calcium and, therefore, increase blood calcium).

-Also stimulates renal 1α-hydroxylation of 25-hydroxy vitamin D (in so doing, PTH indirectly stimulates
intestinal absorption of calcium, contributing to increase blood calcium.

-Also lowers blood phosphate levels

↓Bone Resorption
↑Urinary Loss
↓1,25(OH)2D Production Suppress PTH
-decrease GI
absortion

Rising Blood Ca

Normal Blood Calcium

Falling Blood Ca

↑Bone Resorption
↓Urinary Loss
↑1,25(OH)2D Production Stimulate PTH
-increase GI
absorption

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PARATHYROID GLAND

VITAMIN D

-Shares striking similarities in origin with steroid hormones: vitamin D is a metabolic product of the
cholesterol synthetic pathway.

-Tissues involved in vitamin D synthesis are the skin, liver, and kidneys

-Tissue function affected is gut, bone, and parathyroids.

-Synthesis begins in the skin,

 where 7-dehydrocholesterol is transformed to vitamin D3 (Inactive form)
 An enzyme in the liver, hepatic 25-hydroxylase, metabolizes vit D3 to 25-hydroxy
vitamin D* (detected in the blood to assess adequacy of viatamin D stores in the
body.)
 An enzyme in the kidneys, renal 1α-hydroxylase**, completes the metabolism of
vitamin D to the active metabolite, 1,25-dihydroxy vitamin D (1,25(OH)2D)

*not regulated by any component of the calcium homeostatic system.

**regulated by PTH

-Age, exposure to sunlight, and latitude can influence adequacy of vitamin D.

-Can also be obtained from dietary sources:

Vitamins (multivitamins,supplements)
Vitamin D-fortified Milk
Cod Liver Oil

Skin Liver Kidney

7-Dehydrocholesterol Vitamin D3 25(OH) Vitamin D

Ultraviolet 25-hydroxylase 1α-hydroxylase

Vitamin D3 25(OH) Vitamin D 1,25(OH)2 VitaminD
(Active Metabolite)

Tissue-specific
Vitamin D responses

HYPOPARATHYROIDISM

-The condition of inadequate (or loss of) parathyroid function.

-Most common is postsurgical.

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PARATHYROID GLAND

HYPERPARATHYROIDISM

PRIMARY
-Most common cause of hypercalcemia (in healthy patients)
-A condition resulting from adenoma, multiple adenomas, or hyperplasia of the
parathyroids.
-Increased Blood Calcium, PTH, and Urine Calcium

SECONDARY
-The parathyroids are normal and healthy.
-Elevated PTH in response to threat of hypocalcemia.
-Low or normal Blood Calcium, High PTH level, Usually low Urine Calcium

Rickets and Osteomalacia: Diseases of Vitamin D metabolism

Both diseases exhibit defects in skeletal mineralization (deposition of
Calcium and phosphate, or hydroxyapatite, in bone.)

Osteoporosis: Inevitable consequence of aging

Most prevalent metabolic bone disease in adults.
Causes fracture.

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