Module :LOCOMOTOR

Topic: REGULATION OF PTH

FIRST Year MBBS 2022
Dr. Arisha Sohail
Dep. Of Biochemistry
DIMC,DUHS
Objectives
• determination of the physiological function of the parathyroids,
• determination of the regulation of the parathyroid hormone
• the pathophysiology due to hormone excess or deficiency,
Function
• Effects of the parathyroid glands are exerted through chief cells,
which produce and secrete parathyroid hormone (PTH):

• Regulate calcium levels in the blood

• Calcium-sensing receptors (CaSRs) within chief cells monitor calcium
blood levels and moderate PTH secretion.
• ↓ Blood calcium levels → ↑ secretion of PTH → ↑ serum calcium
PTH effects:
• Stimulation of calcium reabsorption and phosphate excretion in the
distal tubule of the kidney
• Increases renal activation of vitamin D:
• Calcitriol (1,25-dihydroxyvitamin D) is the active form.
• Increases intestinal reabsorption of calcium
• Stimulation of calcium and phosphate release from the bones
through osteoclast activation
PTH secretion regulation:
• Stimulated by:
• Decreases in serum calcium
• Low levels of calcitriol
• Hyperphosphatemia
• Mild hypomagnesemia
• Inhibited by high levels of serum calcium
Hypoparathyroidism
• Hypocalcemia, hyperphosphatemia and tetany
• most commonly post-surgical
• idiopathic disease
• Pseudohypoparathyroidism (resistance to hormone action rather than
defective hormone production)
Hyperparathyroidism
• Depending on the pathogenesis, the presentation may be primary,
secondary, or tertiary hyperparathyroidism
• The most frequent cause is adenomas of the parathyroid gland which
can be localized
• Hyperfunctioning adenomas are typically removed with surgery.
Paradox of PTH biological action: therapeutic
use vs physiological function
Homeostatic role Sustained elevation of PTH can
maintain blood calcium against
challenge of prolonged calcium
deficiency by withdrawal from
bone ‘bank’, reduces bone mass
Therapeutic role Deliberate, short pulses of PTH
dramatically build bone mass. a.
Continuous elevation in PTH blood
levels (>2 hrs): bone mass b.
Intermittent elevation in PTH
blood levels (