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PTH does what?
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Activates bone resorption--> increases serum ca. increases renal tubular ca resorption--> increases serum ca. increases activation of vit D, which helps increase ca absoprtion from the gut
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What does calcitonin do?
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Inhibits bone resorption.
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Hyperparathyroidism: occurs mainly after what age? more commonin men or women? also in 10-20% of ___ pts
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After 40. more common in women. cancer.
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2 most common causes of hypercalcemia?
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*pirmary hyperparathyroidism and malig
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Activated vit d is called?
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Calcitriol
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3 etiologies of primary hyperparathyroidism?
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Solitary parathyroid adenoma (85%), parathyroid hyperplasisa (15%...may be assoicated with hereditary causes, such as multiple endocrine neoplasia [MEN] syndromes), rare cases of multiple aenomas or parathyroid carcinoma
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Cancers can lead to hypercalcemia in what two ways
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*direct bone destruction
*secretion of a PTH-related protein (PTHrp)--> humoral hybpercalecemia of maliganancy = HHM |
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3 cancers assoicated with direct bone destruction?
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Breast, nonsmall cell lung cancer, mutliple myeloma
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Cancers more likely to cause HHM? (4)
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Lung cancer (esp squamous cell), head and neck cancers, renal cancer, t-cell leukemia (assoicated with virus HTLV-1)
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3 vitamin-d mediated causes of hypercalcemia?
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Increased vit d ingestion, granulomatous diseases (eg: sarcoid, tb...granulomas activate vit d thru production of alpha 1 hydroxylase), hodgkin's and non hodgkin's lymphomas
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3 increased bone turnover causes for hypercalcemia?
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Hyperthyroidism, immobilization (usually in association with underlying hihg bone turnover, as seen in Paget disease), vit a intoxication
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Decreased renal excretion of ca causes of hypercalcemia? (3)
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Thiazide diuretics, milk-alkali syndrome
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Describe milk-alkali syndrome.
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Caused by excessive ingestion of antacids or ca supplements...get alkalosis that--> greater renal absorption of calcium, which--> volume depletion and renal insufficiency. cycle continues as long as ingestion persists.
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2 conditions that involve increased PTH secretion but do not = primary parahyperthyroidism?
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Lithium intake adn famiilial hypocalciuric hypercalcemia (FHH)
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*What type of genetic disorder is FHH? *charactersitic?
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*Aut dom. *don't get increased ca in urine even though high serum ca
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