Hypercalcemia pathophysiology: Difference between revisions

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Revision as of 13:45, 4 June 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Pathophysiology

Mineral Homeostasis

The effect of parathyroid hormone on mineral metabolism is as follows:^[1]^[2] Effect of minerals and vitamin D on parathyroid hormone:

Decrease in serum calcium concentration stimulates parathyroid hormone.
Calcium provides negative feedback on parathyroid hormone.
Magnesium provides negative feedback on parathyroid hormone.
Vitamin D decreases the concentration of parathyroid hormone.
Effect on parathyroid hormone on calcium metabolism:
- Direct effect:
  - Increased resorption of bones.
  - Decreases excretion from kidney.
- Indirect effect:
  - Increases conversion of inactive 25-hydroxy vitamin D to the active 1,25-dihydroxy vitamin D which increases absorption of calcium from gut. Decreased phosphate concentration also increases this conversion process. Vitamin D shows synergism with parathyroid hormone action on bone.
  - Decreased serum inorganic phosphate concentration prevents precipitation of calcium phosphate in bones.
- Both these direct and indirect mechanism results in an increased serum calcium concentration.
Effect of parathyroid hormone on inorganic phosphate metabolism:
- Increases excretion of inorganic phosphate from kidney resulting in decreased serum concentration of phosphate.
Effect of parathyroid hormone on magnesium concentration:
- Decreases excretion of magnesium resulting in increased serum magnesium concentretion.

The Sequence of Events in Mineral Homeostasis

Parathyroid hormone

Kidney

Bone

Decreased excretion of magnesium

Increasead conversion of inactive 25-hydroyx vitamin D to the active 1,25-dihydroy xvitamin D

Increase excretion of inorganic phosphate

Decrease excretion of calcium

Increased resorption of bone

Increased serum concentration of magnesium

Increased absorption of calcium from gut

Decreased serum concentration of inorganic phosphate

Prevents precipitation of calcium phosphate in bones

Increased serum concentration of calcium

References

↑ HARRISON MT (1964). "INTERRELATIONSHIPS OF VITAMIN D AND PARATHYROID HORMONE IN CALCIUM HOMEOSTASIS". Postgrad Med J. 40: 497–505. PMC 2482768. PMID 14184232.
↑ Nussey, Stephen (2001). Endocrinology : an integrated approach. Oxford, UK Bethesda, Md: Bios NCBI. ISBN 1-85996-252-1.

Template:WS Template:WH

[pmid14184232-1] HARRISON MT (1964). "INTERRELATIONSHIPS OF VITAMIN D AND PARATHYROID HORMONE IN CALCIUM HOMEOSTASIS". Postgrad Med J. 40: 497–505. PMC 2482768. PMID 14184232.

[2] Nussey, Stephen (2001). Endocrinology : an integrated approach. Oxford, UK Bethesda, Md: Bios NCBI. ISBN 1-85996-252-1.

[1]

[2]

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 __NOTOC__
 {{Hypercalcemia}}
 {{CMG}}; {{AE}}
-{{PleaseHelp}}
 ==Overview==
 ==Pathophysiology==
+===Mineral Homeostasis===
+The effect of [[parathyroid hormone]] on [[mineral]] [[metabolism]] is as follows:<ref name="pmid14184232">{{cite journal |vauthors=HARRISON MT |title=INTERRELATIONSHIPS OF VITAMIN D AND PARATHYROID HORMONE IN CALCIUM HOMEOSTASIS |journal=Postgrad Med J |volume=40 |issue= |pages=497–505 |year=1964 |pmid=14184232 |pmc=2482768 |doi= |url=}}</ref><ref>{{cite book | last = Nussey | first = Stephen | title = Endocrinology : an integrated approach | publisher = Bios NCBI | location = Oxford, UK Bethesda, Md | year = 2001 | isbn = 1-85996-252-1 }}</ref>
+Effect of [[Mineral|minerals]] and [[vitamin D]] on [[parathyroid hormone]]:
+*Decrease in serum [[calcium]] concentration stimulates [[parathyroid hormone]].
+*[[Calcium]] provides [[negative feedback]] on [[parathyroid hormone]].
+*[[Magnesium]] provides [[negative feedback]] on [[parathyroid hormone]].
+*[[Vitamin D]] decreases the concentration of [[parathyroid hormone]].
+*Effect on [[parathyroid hormone]] on [[calcium]] [[metabolism]]:
+**Direct effect:
+***Increased [[resorption]] of [[Bone (disambiguation)|bones]].
+***Decreases [[excretion]] from [[kidney]].
+**Indirect effect:
+***Increases conversion of inactive [[25-hydroxy vitamin D]] to the active [[1,25-dihydroxy vitamin D]] which increases absorption of [[calcium]] from [[gut]]. Decreased phosphate concentration also increases this conversion process. [[Vitamin D]] shows synergism with [[parathyroid hormone]] action on [[bone]].
+***Decreased serum [[inorganic phosphate]] concentration prevents [[Precipitation (chemistry)|precipitation]] of [[calcium phosphate]] in [[Bone (disambiguation)|bones]].
+**Both these direct and indirect mechanism results in an increased serum [[calcium]] concentration.
+*Effect of [[parathyroid hormone]] on [[inorganic phosphate]] [[metabolism]]:
+**Increases [[excretion]] of [[Phosphate|inorganic phosphate]] from [[kidney]] resulting in decreased serum concentration of [[phosphate]].
+*Effect of [[parathyroid hormone]] on [[magnesium]] concentration:
+**Decreases [[excretion]] of [[magnesium]] resulting in increased serum [[magnesium]] concentretion.
+<br><br><br>
+<div style="text-align: center;">'''The Sequence of Events in Mineral Homeostasis''' </div>
+<br>
+{{familytree/start |}}
+{{familytree | | | | | | | | | | | | A01 |A01='''Parathyroid hormone'''}}
+{{familytree | | | | | | | |,|-|-|-|-|^|-|-|-|-|-|-|-|-|-|-|-|-|-|-|.|}}
+{{familytree | | | | | | | B01 | | | | | | | | | | | | | | | | | | B02 | | |B01=[[Kidney]]|B02=[[Bone]]}}
+{{familytree | |,|-|-|-|-|-|+|-|-|-|-|v|-|-|-|-|-|-|.| | | | | | | |!| }}
+{{familytree | C01 | | | | C02 | | | C03 | | | | | C04 | | | | | | C05 |C01=Decreased [[excretion]] of [[magnesium]]|C02=Increasead conversion of inactive [[25-hydroyx vitamin D]] to the active [[1,25-dihydroy xvitamin D]]|C03=Increase [[excretion]] of inorganic [[phosphate]]|C04=Decrease [[excretion]] of [[calcium]]|C05=Increased [[resorption]] of [[bone]]}}
+{{familytree | |!| | | | | |!| | | | |!| | | | | | |!| | | | | | | |!| |}}
+{{familytree | D01 | | | | D02 | | | D03 | | | | | |`|-|-|-|-|.| | |!|D01=Increased serum concentration of [[magnesium]]|D02=Increased absorption of [[calcium]] from [[gut]]|D03=Decreased [[serum]] concentration of inorganic [[phosphate]]}}
+{{familytree | | | | | | | |!| | | | |!| | | | | | | | | | | |!| | |!|}}
+{{familytree | | | | | | | |!| | | | |`|-|-| E01 |-|-|-|-|.| |!| | |!| E01=Prevents precipitation of [[calcium phosphate]] in [[bones]]}}
+{{familytree | | | | | | | |!| | | | | | | | | | | | | | |!| |!| | |!| | | | | |}}
+{{familytree | | | | | | | |`|-|-|-|-|-|-|-|-|-|-|-|-|-|-| F01 |-|-|'| | |F01=Increased serum concentration of [[calcium]]}}
+{{familytree/end}}
+<br><br>
 ==References==