CALCIUM HOMEOSTASIS

COMPILED, SIMPLIFIED ,EDITED and MADE EASY FOR STUDENTS

by

Prof. HemaChandran
Learning Objectives
By the end of this module, the 3rd year student should be able to
--Identify Normal serum Ca level.
--Discuss Calcitonin (CT) : Cellular mechanism of action,
Functions, Control of secretion.
--Discuss Parathormone (PTH) : Site of Secretion,
Cellular mechanism of action, Functions, Control of
secretion.
--Explain Vitamin D Synthesis, Cellular mechanism of
action & Functions.
NORMAL SERUM CALCIUM LEVELS
The calcium ion concentration in the extra cellular
fluid(blood plasma and interstitial fluid) , is normally
about 8.9 to 10.1mg/dl. Which is equalent to 2.4
mEq/L.
0.1% of total body calcium is present in extra cellular fluid.
1% of total body calcium is present in the cells of the
tissues.
98.99% is stored in the bones (bones are the large reservoirs
of calcium)
• Physiology of calcium metabolism , phosphate
metabolism, formation of bone, formation of teeth,
regulation of vitamin D, parathyroid hormone secretion
& calcitonin hormone secretion are closely inter related
and intertwined.
• Calcuim plays a major role in (Functions of calcium)
a) The contraction of skeletal muscles, cardiac muscles and
smooth muscles.
b) Helps in the process of blood clotting
c) Plays important role In the transmission of nerve
impulses
d) In the formation of bones and teeth.
Calcitonin, Mechanism of action
/Function
Calcitonin is a peptide hormone, secreted by thyroid
gland.( by parafollicular cells lying in the interstitial
fluid between the follicles of thyroid gland).
When calcium level increases in blood plasma
(Hypercalcimia),then immediately thyroid gland
secretes calcitonin.
Calcitonin decreases calcium ion concentration in the
blood very rapidly.
This is by means of shifting / deposition of calcium in
the exchangeable bone calcium salts.
Calcitonin also inhibits the activity of osteoclasts
(Osteoclasts promotes calcium pump).
In adult human life, the bones are in dynamic
equilibrium where deposition and reabsorption are
balanced. The exchangeable calcium ions will only
help in remodeling the skeletal bones in the
response to the changing mechanical requirement.
Conversely the effect of calcitonin in children is
much more greater because, in children there is
growth of bones taking place continuously and
constantly. The deposition and reabsorption in
children is as high as 5 gm/day.
Control of Calcitonin secretion.
• There is a direct feedback relationship between
plasma concentration of calcium ions and
Calcitonin secretion.
• Increased plasma concentration of calcium
(Hypercalcemia),will stimulate the thyroid gland
and causes calcitonin secretion.
• 10% increase of calcium in plasma concentration
will cause two folds increased rate of secretion of
calcitonin.
• Therefore stimulus for increased calcitonin
secretion is hypercalcemia.
• Conversly decreased calcium levels
(Hypocalcemia) in plasma inhibits calcitonin
secretion.

Calcitonin and PTH are opposite in their function.
Calcitonin promotes deposition of calcium in bones.
PTH promotes reabsorption of calcium from bones.
• Parathyroid hormone Mechanism of action
/Function
PTH is secreted from Parathyroid gland. There are four
parathyroid glands embedded in the thyroid gland.
Parathyroid gland contains two types of cells.
A) Cheif cells: these cells secrete PTH,
B) Oxyphilic cells: the function of these cells is
uncertain.
PTH is necessary for the maintenance and remodeling
of skeleton.
FUNCTIONS OF PARATHYROID HORMONE
When calcium levels decreases in plasma
(Hypocalcemia), PTH secretion increases.
1.PTH stimulates calcium pump. (pumping of calcium
ions from the bone fluid into extracellular fluid).
2.PTH accelerates/promotes the osteoclasts activity
and there by increases the process of resorption
(reabsorption), of calcium ions from bone and adds
these large amount of minerals to the extracellular
fluid.
3.At the same time PTH also increases /promotes,the
reasbsorption of the calcium ions from the renal
tubules of kidneys. Therefore the net effect of these
two actions is increase in the levels of plasma.
4.PTH also accelerates the synthesis of 1, 25 Dihydroxy
cholecalciferol in the kidney. This metabolite of
vitamin D enhances the absorption of calcium from
intestines.
Control of Para Thyroid Hormone secretion
• To maintain a minimum concentration in the blood
circulation, parathyroid hormone is secreted
continuously at a very low rate.
• There is a direct feedback relationship between
plasma calcium ions and PTH secretion.
• Calcium receptors are present on cell membrane of
cheif cells in the Para thyroid gland.
• Stimulus for increased PTH secretion is
Hypocalcemia (decreased levels of calcium in
plasma). When calcium levels goes below 9
mgs/100ml then immediately PTH is secreted.
• Conversely inhibiton of PTH release is due to
Hypercalcemia (increased levels of calcium in
plasma).
Vitamin D synthesis
• Much of vitamin D that is required for the body is
required by diet. ( Fish/eggs. ) (400 IU for children and
100 IU for adults is the daily requirement).
• Vitamin D3 (also called as Cholecalciferol) is
synthesized in skin, when skin is exposed to ultra violet
rays from sun. Vitamin D3 is biologically inactive, and
so it undergoes hydroxylation to become active.
• The first hydroxylation takes place in liver, where
cholecaciferol(Vit D3) is converted into 25
hydroxycholicalciferol. This can be stored in liver for
few weeks.
• The second hydroxylation takes place in kidneys,
where 25 hydroxycholicalciferol is converted into 1,25
dihydroxycholecalciferol (this is an active form of
vitamin D)
• 1,25 dihydroxycholecalciferol is also called as
CALCITRIOL.
• Both cholicalciferol and 25 hydroxy cholicalciferol are
inactive forms and their effect is 1/1000 of calcitriol
effect. Therefore in the absence of kidneys vitamin D
loses all its effectiveness.
• Conversion of 25 hydroxycholicalciferol into 1,25
dihyroxycholicalciferol (calcitriol) in kidneys needs
ParaThyroid Hormone.
 Functions of vitamin D
• 1. Hormonal effect of vitamin “ D “ to promote intestinal calcium
absorption.
Caclitriol itself acts as a special type of hormone to promote absorption of
calcium from intestines. Calcitriol forms a calcium binding protein in the
brush border of the cells of intestine. This protein helps in transferring the
calcium into the cell cytoplasm. It facilitates diffusion.
• 2. Vitamin D promotes absorption of phosphates from the intestines.
By means of absorbing calcium, phosphate is also is absorbed along with
calcium, because calcium acts as a transport mediator for phosphates.
• 3. Vitamin D decreases renal excretion of calcium and phosphate.
Vitamin D enhances/increases/accelerates the absorption of calcium and
phosphates in the renal tubules of the kidney and as a result prevents
their excretion.
• 4. Effect of Vitamin D on bone
Vitamin D plays a major role in the deposition as well as absorption
processes of calcium, between bone fluid and extra cellular fluid.
However the mechanism of vitamin D is unknown.
5. Vitamin D is important for typical growth and development of bones
and teeth,