endocrine 4

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Questions and Answers

What is a potential effect of hypercalcemia on the body?

  • Increased cardiac contractility
  • Formation of bone fractures
  • Increased muscle strength
  • Mineralization of soft tissues (correct)

What percentage of total body calcium is found in bones and teeth?

  • 90%
  • 70%
  • 99% (correct)
  • 50%

Which physiological function is NOT regulated by calcium homeostasis?

  • Skeletal muscle contraction
  • Blood coagulation
  • Heart rate regulation
  • Protein synthesis (correct)

What condition may result from low calcium levels in the body?

<p>Tetany in dogs and cats (C)</p> Signup and view all the answers

Which hormone plays a key role in calcium regulation by acting on bones, the GI tract, and kidneys?

<p>Parathyroid hormone (PTH) (C)</p> Signup and view all the answers

What condition results in softening of bones in adults due to high PTH levels and vitamin D deficiency?

<p>Osteomalacia (D)</p> Signup and view all the answers

What physiological effect does high extracellular fluid [Ca2+] have on muscle and nerve excitability?

<p>Depressed excitability (C)</p> Signup and view all the answers

What is a possible consequence of high concentrations of calcium in renal filtrate?

<p>Kidney stones (C)</p> Signup and view all the answers

In hypocalcemia, what is the expected response of calcium regulatory hormones?

<p>Increased Vitamin D synthesis (D)</p> Signup and view all the answers

What is the typical calcium level in a lactating dairy cow experiencing hypocalcemia?

<p>6.8 mg/dL (C)</p> Signup and view all the answers

Which tissues express calcium sensing receptors (CasR)?

<p>Parathyroid cells and kidneys (C)</p> Signup and view all the answers

What effect does high serum calcium levels have on PTH secretion?

<p>It decreases PTH secretion (D)</p> Signup and view all the answers

Which receptor is classified as the classical PTH receptor?

<p>PTH1R (A)</p> Signup and view all the answers

How does PTH act on bone to increase plasma calcium levels?

<p>By promoting bone resorption (A)</p> Signup and view all the answers

Which of the following statements about PTH binding is correct?

<p>PTH binds to PTH1R on target cells in bone and kidney (B)</p> Signup and view all the answers

What percentage of total calcium in the body is free ionized calcium (Ca2+)?

<p>45% (D)</p> Signup and view all the answers

Which tissue is NOT involved in the regulation of total body calcium levels?

<p>Liver (A)</p> Signup and view all the answers

Which hormone primarily increases blood calcium levels?

<p>Parathyroid hormone (PTH) (C)</p> Signup and view all the answers

What is the primary function of calcitonin in relation to calcium levels?

<p>Decrease blood calcium levels (C)</p> Signup and view all the answers

What triggers the release of parathyroid hormone (PTH) from the parathyroid glands?

<p>Low extracellular calcium levels (D)</p> Signup and view all the answers

Which of the following processes is NOT a function of PTH?

<p>Inhibition of vitamin D activation (A)</p> Signup and view all the answers

How is parathyroid hormone (PTH) stored in the body?

<p>In secretory vesicles of chief cells (C)</p> Signup and view all the answers

Which statement best describes the complexed form of calcium in the body?

<p>It is typically associated with anions like PO4 and SO3. (A)</p> Signup and view all the answers

What is the primary function of parathyroid hormone (PTH) in bone?

<p>To increase bone resorption (C)</p> Signup and view all the answers

How does PTH increase calcium reabsorption in the kidneys?

<p>By inhibiting the excretion of calcium in the distal tubules (B)</p> Signup and view all the answers

What is the main effect of vitamin D on calcium levels in the body?

<p>Promotes calcium absorption in the intestines and increases bone calcium release (C)</p> Signup and view all the answers

Which of the following is NOT a direct stimulator of 1α-hydroxylase activity in the kidney?

<p>High plasma phosphate (B)</p> Signup and view all the answers

What is the role of calcitonin in the regulation of calcium homeostasis?

<p>To decrease plasma calcium levels by inhibiting bone resorption and promoting calcium excretion (C)</p> Signup and view all the answers

Which of the following factors is MOST likely to increase calcitonin secretion?

<p>High plasma calcium levels (D)</p> Signup and view all the answers

What is the primary mechanism by which calcitonin lowers blood calcium levels?

<p>Inhibiting osteoclast activity and promoting calcium excretion (A)</p> Signup and view all the answers

Which of the following conditions is MOST likely to result in hypocalcemia?

<p>Vitamin D deficiency (D)</p> Signup and view all the answers

Which of the following is a potential consequence of hypoparathyroidism?

<p>Tetany (A)</p> Signup and view all the answers

Which of the following is a primary mechanism by which active vitamin D increases calcium absorption in the intestines?

<p>Activating the production of calcium-binding proteins like calbindin (A)</p> Signup and view all the answers

Which of the following is TRUE about the regulation of 1α-hydroxylase activity by phosphate?

<p>High phosphate levels inhibit 1α-hydroxylase (D)</p> Signup and view all the answers

What are the primary stimuli for PTH secretion?

<p>Low blood calcium and high phosphate levels (C)</p> Signup and view all the answers

Which two of the following hormones directly promote bone resorption?

<p>Parathyroid hormone (A), Vitamin D (C)</p> Signup and view all the answers

How does Vitamin D regulate calcium homeostasis?

<p>It enhances the effects of PTH by promoting calcium absorption and bone resorption (B)</p> Signup and view all the answers

Which of the following is NOT a role of calcitonin in calcium homeostasis?

<p>Promoting bone formation by stimulating osteoblasts (D)</p> Signup and view all the answers

What is the primary physiological role of calcitonin in regulating blood calcium?

<p>Playing a more minor role in bone remodeling compared to PTH (D)</p> Signup and view all the answers

Flashcards

Calcium Sensing Receptor (CaSR)

A type of receptor that detects changes in blood calcium levels, triggering responses to maintain calcium homeostasis.

Parathyroid Hormone (PTH)

The main hormone involved in increasing blood calcium levels. It is secreted by the parathyroid glands.

Bone Resorption

A process that breaks down bone to release calcium into the bloodstream. This is one of the ways PTH increases blood calcium levels.

Osteoclast cells

The cells responsible for resorbing bone tissue, breaking it down to release calcium.

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PTH1 Receptor (PTH1R)

The primary target of PTH that is responsible for increasing calcium reabsorption in the kidneys, thus increasing blood calcium levels.

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Calcium Homeostasis

Calcium (Ca2+) is vital for bone health, cell signaling, nerve function, muscle contraction, and blood clotting.

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Vitamin D Activation

Vitamin D is synthesized in the skin with sunlight exposure. It is then activated in the kidneys to increase calcium absorption from the gut, ultimately leading to higher blood calcium levels.

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Calcitonin's Role

Calcitonin, produced by the thyroid gland, works opposite of PTH by decreasing blood calcium levels. It primarily inhibits bone resorption, reducing the release of calcium from bones.

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Calcium Imbalance

High blood calcium causes hypercalcemia, leading to soft tissue mineralization, excess urination and thirst, and cardiac problems. Low blood calcium results in hypocalcemia, causing weakness, tetany (muscle spasms), low blood pressure, and compromised heart function.

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Calcium forms in the body

Calcium (Ca2+) exists in three forms in the body: Free ionized (45%), Protein-bound (50%), and Complexed (5%). Only the free ionized form is biologically active.

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Why is calcium important?

Calcium is vital for various bodily functions, including bone formation, muscle contraction, nerve impulse transmission, and blood clotting.

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What is the parathyroid hormone (PTH) function?

The parathyroid glands produce parathyroid hormone (PTH), which plays a crucial role in regulating calcium levels in the blood.

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How does PTH raise blood calcium?

PTH increases blood calcium levels by promoting calcium release from bones, decreasing calcium excretion in the kidneys, and enhancing calcium absorption in the intestines.

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When is PTH released?

PTH is secreted in response to low blood calcium levels, providing a feedback mechanism to restore normal calcium balance.

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How does PTH affect phosphate levels?

PTH increases renal excretion of phosphate, which aids in raising blood calcium levels. This effect is less prominent than its effect on calcium.

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Where are the parathyroid glands located?

The parathyroid glands are small, oval-shaped structures located on the posterior surface of the thyroid gland.

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What is the significance of the parathyroid glands?

The parathyroid glands are vital regulators of calcium homeostasis, ensuring that the appropriate amount of calcium is available for essential bodily functions.

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What is parathyroid hormone (PTH) and its function?

Parathyroid hormone (PTH) is a hormone produced by the parathyroid glands. It plays a crucial role in regulating blood calcium levels by stimulating calcium release from bones, increasing calcium reabsorption in the kidneys, and promoting calcium absorption in the intestines.

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What is active vitamin D and its function?

Active vitamin D, also known as calcitriol, is a steroid hormone produced primarily in the kidneys. It stimulates calcium absorption in the intestines, helping to maintain healthy blood calcium levels.

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How does the body respond to low calcium (hypocalcemia)?

Low calcium levels (hypocalcemia) trigger the release of PTH and active vitamin D, which work to increase blood calcium levels. PTH stimulates bone resorption, kidney reabsorption, and intestinal absorption of calcium. Active Vitamin D enhances calcium absorption by the intestines.

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How does the body respond to high calcium (hypercalcemia)?

High calcium levels (hypercalcemia) trigger the release of calcitonin, a hormone produced by the thyroid gland. Calcitonin lowers blood calcium levels by inhibiting bone resorption, increasing calcium excretion by the kidneys, and reducing calcium absorption in the intestines.

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What are rickets and osteomalacia, and what causes them?

Rickets is a bone disorder in children caused by vitamin D deficiency, leading to soft and weak bones. It is characterized by bowed legs, skeletal deformities, and delayed growth. Osteomalacia is the adult equivalent of rickets, also caused by vitamin D deficiency but results in softening of bones.

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PTH's Action on Kidneys I

PTH increases the reabsorption of calcium in the distal tubules of the kidneys, effectively reducing calcium excretion.

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PTH's Action on Kidneys II

PTH promotes the excretion of phosphate in the kidneys, which helps to increase the amount of free calcium in the bloodstream.

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PTH's Action on Vitamin D

PTH plays a vital role in activating vitamin D, a key player in calcium absorption from the gut.

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Vitamin D

A steroid hormone that acts like a vitamin, essential for calcium absorption in the gut and bone health.

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Vitamin D Activation: Liver

The liver adds the first hydroxyl group to vitamin D, converting it into 25-hydroxyvitamin D (25-OH D3).

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Vitamin D Activation: Kidneys

The kidneys add the second hydroxyl group to vitamin D, converting it into 1,25-dihydroxyvitamin D (Calcitriol), the active form.

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1alpha-hydroxylase

The enzyme responsible for the final step in vitamin D activation, converting 25-OH D3 into calcitriol.

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Vitamin D's Effect on Intestine

Active vitamin D (calcitriol) promotes the absorption of calcium from the intestines by increasing expression of calcium transport proteins.

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Vitamin D's Effect on Bones

Active vitamin D (calcitriol) promotes osteoclast activity in bones, causing bone resorption and release of calcium into the bloodstream.

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Calcitonin

A peptide hormone produced by the parafollicular cells of the thyroid gland, responsible for lowering plasma calcium levels.

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Calcitonin's Effect on Bones

Calcitonin inhibits the activity of osteoclasts, reducing bone resorption and the release of calcium from bones.

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Calcitonin's Effect on Kidneys

Calcitonin reduces calcium reabsorption in the kidneys, leading to increased calcium excretion.

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Calcitonin's Effect on Intestines

Calcitonin inhibits the absorption of calcium from the gut.

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Hypoparathyroidism

A condition characterized by abnormally low levels of PTH, leading to hypocalcemia and potentially life-threatening tetany.

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Hyperparathyroidism

A condition characterized by abnormally high levels of PTH, typically caused by a tumor in the parathyroid gland. Can lead to hypercalcemia.

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Study Notes

Parathyroid Glands and Calcium Regulation

  • Parathyroid glands are small, oval-shaped structures located on the posterior surface of the thyroid gland.
  • These glands produce parathyroid hormone (PTH).
  • Calcium homeostasis is crucial for various physiological functions, including bone and tooth formation, skeletal integrity, intracellular signaling, nerve and muscle function, and blood clotting.
  • Calcium levels in the body are tightly regulated within a narrow range (8.5-10.3 mg/dL) using various mechanisms to maintain the proper balance.
  • Calcium exists in three forms: 45% ionized calcium (Ca2+), 50% bound to plasma proteins (primarily albumin), and 5% combined with anions like phosphate and sulfate. Only the ionized form (Ca2+) is biologically active.
  • Ninety-nine percent of total body calcium is stored in bones and teeth; the remaining portion is found in soft tissues and extracellular fluid.

Calcium Homeostasis

  • Calcium levels are tightly regulated by the interplay of several hormones: parathyroid hormone (PTH), vitamin D, and calcitonin.
  • These hormones influence calcium absorption, release, and excretion across different tissues, including the gastrointestinal tract, bone, and kidneys.

Regulation of Calcium Levels (The Three 3's)

  • The regulation of calcium levels within the body relies on the coordinated actions of three principal components:
    • 3 Tissues: Gastrointestinal tract (dietary intake and fecal excretion), Bone (storage and release), and Kidneys (urinary excretion)
    • 3 Processes: Calcium absorption (GI tract), Calcium resorption/deposition (bone), and Calcium reabsorption (kidney)
    • 3 Principal Hormones: Parathyroid hormone (PTH), 1,25-dihydroxy Vitamin D3/Calcitriol (active vitamin D3), and Calcitonin

Parathyroid Hormone (PTH)

  • PTH is a protein hormone (84 amino acids).
  • Its primary functions include maintaining calcium homeostasis by increasing blood calcium levels. This is achieved through:
    • Increasing bone resorption, releasing calcium from the bone matrix
    • Increasing renal calcium reabsorption and reducing renal phosphate reabsorption
    • Activating Vitamin D, enhancing calcium absorption in the intestines.

Vitamin D

  • Vitamin D is a hormone, not a true vitamin, and is involved in calcium homeostasis.
  • Two main sources: Synthesis in the skin from UV light, and dietary sources.
  • Vitamin D must be converted to its active form, 1,25-dihydroxyvitamin D3 (calcitriol), through a two-step process occurring primarily in the liver and kidneys.
  • 1,25-(OH)2 Vitamin D3 (Calcitriol) binds to specific receptors, influencing target genes for calcium homeostasis within cells.

Calcitonin

  • Calcitonin is a peptide hormone (32 amino acids) produced by the parafollicular cells (C cells) of the thyroid gland.
  • Calcitonin opposes the effects of PTH, helping regulate blood calcium levels by:
    • Inhibiting osteoclast activity preventing the breakdown of bone (bone resorption)
    • Decreasing the reabsorption rate of calcium in the kidneys to increase excretion
    • Reducing calcium absorption from the intestines. Calcitonin lowers plasma calcium levels.

Disruption of Calcium Homeostasis

  • Hypoparathyroidism: Rare condition caused by autoimmune disease, resulting in low PTH secretion, causing hypocalcemia (low blood calcium) and neuromuscular excitability issues (e.g., muscle spasms).
  • Hyperparathyroidism: Usually due to a hypersecreting parathyroid tumor and high PTH levels, leading to hypercalcemia (high blood calcium). Chronic renal disease or vitamin D deficiency can sometimes cause hyperparathyroidism as well.

Calcitonin Secretion Regulation

  • Plasma calcium level regulates calcitonin secretion. Low serum Ca2+ level inhibits calcitonin release, whereas high levels stimulate it.

Clinical Problems

  • High PTH and Vitamin D Deficiency: Leading to bone demineralization. Rickets (in children) and osteomalacia (in adults) are common consequences.
  • Low Calcium: Can lead to decreased muscle and nerve excitability, an increased risk of fractures, and kidney stones.

Actions in Response To Conditions

  • Low calcium levels (Hypocalcemia): PTH is released to increase calcium levels. Vitamin D activation is also stimulated.
  • High calcium levels (Hypercalcemia): Calcitonin is released to decrease calcium levels.

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