Endocrinology Part 3

Pathophysiology

April 2023 Johanna Namene

jnamene@unam.na
Calcium homeostasis
Vitamin D
Parathyroid gland and disorders
Function of PTH

Increase serum calcium concentration

Decrease the concentration of serum phosphate

Importance of Calcium
Three important hormones that regulate calcium

Parathyroid hormone: PTH

Vitamin D (active form: calcitriol)

Calcitonin
1 alpha-
hydroxylase
 Parathyroid hormone
Produced by the Chief cells – a low calcium level
activated the chief cells to release the PTH

Main function - Increase calcium level in the

blood

1. Absorption in GI - increase vitamin D

2. Reabsorption in kidney

3. Bone resorption
Keeps calcium levels between 8.5-10 mg/dL
Hyperparathyroidism
Characterized by excess parathyroid hormone (PTH) in the blood, resulting in hypercalcemia

Classification

Primary
Secondary
Tertiary
Hyperparathyroidism
Primary
Causes: parathyroid adenoma, parathyroid hyperplasia, parathyroid carcinoma

Genetic causes: Multiple endocrine neoplasia [MEN] types 1 and 2a

Not under the usual feedback control mechanisms

Features:
• Increased parathyroid hormone production
• Increased effects on bone resorption
• Hypophosphatemia and hypercalcemia
Hyperparathyroidism
Secondary

Occur as a result of a medical condition example chronic kidney failure, severe vitamin D
deficiency

Features
• severe calcium deficiencies (hypocalcemia)
• Impaired phosphate excretion - Hyperphosphatemia
• High level of PTH
Hyperparathyroidism
Tertiary

• Long term secondary hyperparathyroidism

• Long term hypocalcemia
• Low level of calcium continues to stimulate the parathyroid to secrete PTH which can
cause parathyroid chief cell hyperplasia
• Parathyroid gland release excess PTH

Features:
High PTH
High calcium level
Hyperphosphatemia – kidney disease
Hypoparathyroidism
Low PTH, resulting in Hypocalcemia
Causes: Damage during thyroid surgery
DiGeorge syndrome
Idiopathic and autoimmune

Pseudohypoparathyrodism
PTH levels normal - PTH resistance in the kidney or bones

Leads to: Hypocalcemia and Hyperphosphatemia

DiGeorge syndrome
Microdeletion on long arm of chromosome 22; underdeveloped parathyroid gland

Features:

CATCH 22
C – cardic abnormality
A – abnormal facies
T – thymus aplasia
C – cleft palate
H – hypoparathyroidism
22 – Chromosome 22 (22q11.2)
DiGeorge syndrome
Microdeletion on long arm of chromosome 22; underdeveloped parathyroid gland
Vitamin D (Calcitriol)
Vitamin D

Steroid hormone

Active form: calcitriol

Facilitate absorption of calcium and phosphorus from GI

Increases calcium reabsorption by the kidney

Inhibits parathyroid hormone secretion

Stimulate osteoclasts for bone resorbtion

Calcium regulation in the bones

Osteoclast

Osteoblast
 Calcitrol and bone
Deficiency in calcitrol

Osteomalacia/rickets: soft bone

Osteoporosis: deterioration of bone mass over time

Younger individuals

Defect in mineralisation of cartilage at the growth plates

*osteoporosis bones are porous and brittle,

osteomalacia bones are soft
Calcium
Hypocalcemia
Lower than normal calcium level in the blood (<8.5 mg/dL)

Secondary Hyperparathyroidism

Hypoparathyroidism

DiGeorge syndrome

Osteoporosis
Hypocalcemia
Respiratory alkalosis – A process that raises blood pH >7.45

Occurs when the respiratory system fails to carry out its

normal pH- balancing job

Increase protein binding

Clinical manifestation: Hypocalcemia

Hyperactive reflexes
Tingling, tetany, seizures(severe)

Osteodystrophy

Cardiac arrhythmia’s

Prolonged QT interval
Hypocalcemia
How do we test for it?
Trousseau sign

https://www.youtube.com/watch?v=SFVQFLJbir0
Chvostek sign
Tapping the face over the facial nerve

https://www.youtube.com/watch?v=k599AcihIGg
Hypercalcemia
>10.2 mg/dl

Primary & Tertiary Hyperparathyroidism

Excessive Vitamin D

Increased intestinal absorption of Calcium

Familial Hypocalciuric Hypercalcemia

Respiratory acidosis (pH<7.35)

Hypoalbuminemia
Clinical manifestation - Hypercalcemia

Decreased neural excitability

Kidney exposed to high concentration of calcium: kidney stones

Stupor/coma

Shortened QT interval
Hypercalcemia
Shortening of the QTinterval

Osborn wave
 Practice Mix & Match

A disorder of vitamin D deficiency leading to soft bones Osteoporosis

Bone cells that causes bone resorption Hypocalcemia

Bone cells that causes bone mineralization Hypercalcemia

Deterioration of bone mass leading to porous and brittle Osteoblast

bones
Respiratory Alkalosis is associated with… Osteomalacia

Respiratory Acidosis is associated with… Osteoclast