HORMONES THAT

REGULATE CALCIUM
METABOLISM
PARATHYROID ( PTH )
CALSITRIOL
CALSITONIN

DEVIATION OF CALCIUM REGULATION : LIVE THREATENING

CALCIUM ROLE :
NEUROMUSCULAR EXCITABILITY
BLOOD COAGULATION
SECRETORY PROCESS
MEMBRANE INTEGRITY
PLASMA MEMBRANE TRANSPORT
ENZYMES REACTION
RELEASE HORMONES AND NEUROTRANSMITTER
HORMONES ACTION

1 KG CALCIUM IN OUR BODY, 90 % IN BONE

1% OF BONE CALCIUM IS FREELY EXCHANGEABLE WITH
EXTRACELLULAR FLUID CALCIUM

PLASMA CALCIUM :
COMPLEX WITH ORGANIC ACID
PROTEIN BOUND (ALBUMIN > GLOBULIN)
IONIZED FORM : IMPORTANT FOR BIOLOGIC ACTIVITY
1.1 1.3 mmol/L
CONC. CHANGE : MUSCLE PARALYSIS
COMA

HYPOALBUMIN : DECREASE CALCIUM PLASMA

ACIDOSIS

: INDREASE IONIZED FORM CALCIUM

ALKALOSIS

: ENHANCE BINDING TO ALBUMIN

DECREASE IONIZED FORM

PTH (PARATHYROID HORMONE)

PREPROPARATHYROID HORMONE

PTH
PTH ACTION
REC

AC
G PROT
CAMP

KINASE

BIOLOGIC RESPONS

PTH AFFECTS CALCIUM HOMEOSTASIS

1. INCREASE DISSOLUTION OF BONE

2. REDUCE RENAL EXCRETION OF CALCIUM
3. INCREASE CALCITRIOL IN INTESTINE

Ca ABSORPTION

4. INCREASE RENAL EXCRETION OF PHOSPHATE

PATHOPHYSIOLOGY
TYROID SURGERY, AUTOIMMUNE DISEASE
SERUM : CALCIUM

PHOSPHATE

HYPOPARATHYROIDISM
MUSCLE CRAMP
TETANY
LARINGOSPASM
DEATH
CATARACT

PSEUDOHYPOPARATHYROIDIMS (INHERITED)
NORMAL PTH, DEFECT IN G PROT OR DOWNSTREAM CAMP SIGN.
SHORT STATURE,
SHORT METACARPAL METATARSAL
MENTAL RETARDATION

HYPERPARATHYROIDISM
CAUSES : PARATHIROID ADENOMA
PARATHYROID HYPERPLASIA
PTH RELATED PEPTIDE (PTHRP) PRODUCE BY MALIGNANCY
SERUM:
CALCIUM INREASE
PHOSPHATE DECREASE
EXTENSIVE RESORBTION OF BONE
KIDNEY STONE
URINARY TRACT INFECTION
DECREASE RENAL FUNCTION

SECONDARY HYPERPARATHYROIDISM
RENAL FAILURE

DECREASE PRODUCE OF CALCITRIOL

IN RENAL PARENCHYMA

CALCIUM ABSORBPTION IN GUT

PTH

CALCITRIOL

RICKETS

CALCITRIOL

DIET

CALCITRIOL ACTION
THROUGH NUCLEAR RECEPTOR

CALCITRIOL EFFECT :
INCREASE ABSORPTION OF CALCIUM AND PHOSPHATE

PATHOFPHYSIOLOGY
RICKETS
LOW PLASMA CALCIUM AND PHOSPHATE
SKELETAL DEFORMITY
INHERITED AD : DEFECT IN CONVERSION 25OH-D3 TO CALCITRIOL
AR : DEFECT IN CALCITRIOL NUCLEAR RECEPTOR

VIT D DEFICIENCY IN ADULT

OSTEOMALACIA

CALCITONIN
32 AMINO ACID
PRODUCED BY PARAFOLLICULAR CELL OF TYHROID
ROLE IN CALCIUM HOMEOSTASIS : UNCLEAR