161b Ca/PTH/Bone path Flashcards Preview

Endocrine - DVR > 161b Ca/PTH/Bone path > Flashcards

Flashcards in 161b Ca/PTH/Bone path Deck (32):
1

hypercalcemia - what test should be used?

PTH (along with Ca level)

2

hypercalcemia presentation

stones - nephrolithiases (+ polyuria)

bones - cortical bone, distal phalanges, salt and pepper skull

groans - constipation

psych overtones - depression, psychosis

3

hypercalcemia treatment?

hydration - Ca causes fluid loss
loop diuretics (furosemide)
calcitonin
IV bisphosphonates
glucocorticoids
dialysis

4

primary hyperPTH?

most common cause of hyperCa
85% benign single adenoma, but can be carcinoma or hyperplasia x 4

5

primary hyperpth - clinical test results? Rx?

high PTH
high Ca - serum and urine

Rx - same as hyperCa
Calcimimetics (cinacalcet)

6

cinacalcet

calcimimetics

controls serum calcium, but doesn't improve bone disease

7

sestamibi scan

radiolabeled tracer that finds hyperPTH for surgery

8

fmalilal hypocalcuria hypercalcemia (FHH)

AD - inactivation of CaR allele (just one allele)

body thinks less Ca so releases more PTH

low Ca in urine (<1% for ca:creatinine ratio)

Rx - observation

9

neonatal severe hyperPTH

AR

both CaR are bad --> high PTH and high Ca

bad

10

secondary hyper PTH?

approiatpe hihg PTH from low Ca from chronic renal failure or vit d deficiency

11

tertiary hyper PTH

long standing renal filure lead to autonomous PTH secretion

12

cancer and high Ca

1) PTHrP - binds PTH

2) tumors invade bone and produce osteolytic factors

3) ectopic production of active 1,25 Vit D
--> 1 a hydroylase
leukemia, lymphoma

13

hypocalcemia

most common cause is low albumin

measurement error (correct when albumin <4)

14

hypoCa featurs

neuromuscular irrability

faicial twiching with Chvostek's

Trousseasu's sign --> spasm of forehand and hand when occulded with blood p cuff

15

hypoPT

rare - due to surgery
DiGeorge syndrome
hypomagnesisemia

16

Mg and Ca

PTH secretion depends on Mg b/c binds to CaSR

17

kidney failure

high PO4 --> lowers Ca in serum
reduced 1 a hydroxylase enzyme

18

acute pancreatitis

deposition of Ca --> low Ca in blood

19

hypoCa rx

Ca IV
Vit D
calcitriol

teriparatide

20

phosphate

kidney gets rid of most of it
Na dependent via PTH - NPt2 cotransporter brings both in when PO4 low

21

rickets (kids) and osteomalacia (adults)

usually Vit D deficiency --> low Ca absopriton --> high PTH --> bone resorption

Ca is serum maintained at normal levels at the expense of bone

defect in bone minerilzation (cant form normal healthy bone)

22

rickets (kids) and osteomalacia (adults) - clincal feasutres

bone pain
bowing of the legs
weakness, fatigue, low muscle tone

23

major source of vit D in diet?

salmon is best
milk has some

24

storage form of vit D?

25 OH --> check this level

25

Rx for rickets/osteomalcaci

cholecalciferol
ergo
calcitirol

26

osteoporosis

decreased bone density and bone quality

T <= -2.5 SD

T score compares to young adults
Z score compares to age/sex matched

27

goal of osteporosis preventation

maximize peak bone mass in adolsecence

28

who should get rx for osteoporsis?

t score < 2.5 SD

osteopenia = -1 to 2.5 SD for T score

29

meds for osteoporiss

anabolic -teriparatide

anti-resorptive
estrogen
SERMS
calcintonin
denosumab
bisphohates

30

paget's disease

any cause of hyper PTH --> hyperdynamic bone remodeling - increased OB and OC actviity

high alkaline phosphatase

31

paget's feaures

nerve compression/entrapment -> hearing loss, pain, etc

xray - thick bones, hyperlucent bone, overgrowth
cotton wool from irrgular scelrosis in skull

bone scan - pelvis, spine, skull

labs - normal Ca, phosphorus, PTH

32

pageat's rx

bispohphonate - high doses

calcitonin