Calcium Homeostasis

CALCIUM INTAKE
1g
30% - upper smaller intestine
Diet
Age
Hormones
Pregnancy & lactation
CALCIUM BALANCE
Abs. Ca exc. Ca
Affected by age and some diseases
Children: (+) calcium balance
Adults: input and output should be the same
Postmenopausal women: (-) calcium balance
CALCIUM IN THE BLOOD
NR: 2.12-2.65 mmol/L (8.5-104.mg/dL or 2.1-2.26
M)
dependent on dietary intake
regulation involves loss or gain from
kidneys, intestines, bones
20% of bones
40-45% bound to albumin
dec: hypercalcemic symptoms
10% - citrate & PO4
minor extent to cells ionized
hypocalcemic symptoms
Pathophysiology and Morphology
ADENOMA
inferior parathyroid glands
6-10% - thymus, thyroid, pericaridium or esophagus
0.5-5.0 g 10-20g
Chief cells
asymmetric enlargement
histo: uniform pattern of CC and disappearance of fat
morphology
solitary, similar to N pThyroid cells, close proximity to
gland/ectopic
well-circumscribed, soft, tan to reddish-brown nodule,
delicate capsule
gland may be normal or shruken in size
 mx:
fairly uniform, polygonal CC w. small centrally-placed
nuclei
oxyphil adenoma
Hurthle cells
rim of compressed, nonneoplastic pTHy tissue,
fibrous capsule at egde
endocrine atypia
inconspicuous adipose tissue
PRIMARY HYPERPLASIA
sporadic or component of MEN syndrome
classic: all four glands
hyperplasia vs adenoma
mx:
CC hyperplasia
water-clear cell hyperplasia
oxyphil cells
poorly developed, delicate fibrous strands
stromal fat inconspicuous
PARATHYROID CARCINOMA
circumscribed lesions or invasive neoplasm
unilateral enlargement
gray-white, irregular masses
cells: uniform, resemble N pThy cells
nodular/trabecular pattern w. dense fibrous capsule
invasion of surrounding tissue or metasis
SKELETAL & RENAL
inc # of osteoclasts
bone resorptx w. inc osteoblastic activity & formation of
new trabeculae
resemble tuberculosis
osteitisfibrosacystica
nephrolithiasis
nephrocalcinosis
metastatic calcificax 2 to hypercalcemia