Day 12 Endocrine

अब Quizwiz के साथ अपने होमवर्क और परीक्षाओं को एस करें!

Adjusted Calcium=_______

(4.0-actual albumin)*.8 + total calcium=adjusted calcium

Osteoporosis can be diagnosed in a patient with a T-score of ____ or lower

-2.5

The important assessment for osteoporosis Tx effectiveness is _____

-reduction of patient fractures -improved BMD -proper change in bone turnover

prolonged bed-rest plus subpar kidney function can cause bone ____1 (resorption/formation)___, and hypercalcemia

1 bone resorption

To test an anti-resorptive osteoporosis agent, you are looking for decreased bone ___1___, and markers you look for are ___2__

1 decreased resorption 2 collagen cross-links (NTx, CTx)

While bisphosphonates increase BMD, decrease bone turnover, and decrease fracture risk, worry about __1__ irritation, and ____2__ of the jaw

1 esophagus 2 osteonecrosis

To test an anabolic osteoporosis agent, you are looking for increased bone ___1___, and markers you look for are ___2__

1 increased bone formation 2 P1NP, bone specific alkaline phosphatase

In the KIDNEY, (with PTH), 25 (OH2) Vitamin D is turned into

1,25 vitaminD

______ is a steroid hormone that acts of nuclear transcription to increase calcium and phosphorous absorption in the gut and can stimulate bone resorption

1,25vitamin D

Granulomas have increased expression of _______, causing high levels of 1,25vitaminD

1-hydroxylase

what catalyzes 25(OH2)vitaminD to 1,25vitaminD

1-hydroxylase

You start preventative osteoporosis treatment if their FRAX assessment for osteoporotic fracture risk is greater than _1__% and their hip fracture risk is greater than _2_%

1. 20% 2. 3%

In the liver, vitamin D3 is turned into ____

25 (OH2) Vitamin D

If vitamin D deficiency precipitates from VERY severe liver disease, it is because ______ enzyme activity is impaired.

25-hydroxylase

______ is the precursor in the skin that is turned into vitamin D3

7-dehydrocholesterol

Vitamin ____ is a cofactor for vitamin D, so toxicity of it will increase bone resorption

A

______ is a drug that binds to hydroxyapatite in the bone that inhibits bone resorption. It has a long skeletal retention and low GI absorption.

Bisphosphonates (alendronate, Risedronate,Ibandronate)

______ sign is when you touch a patient's check and the corner of their mouth spasms. It is positive in patients with hypocalcemia

Chvostek's sign

____ syndrome is a genetic syndrome that is assocaited with abnormal parathyroid development, causing primary hypoparathyroidism

DiGeorge syndrome

_____ is a autosomal dominant syndrome that is classified as asymptomatic hypercalcemia. While the body responds and increases PTH, the kidney has a defect in his ca2+ sensing receptor, meaning urine calcium will be low

FHH

A patient with FHH can also have resistance to ______.

FSH, LH, and TSH

_______ is a genetic disorder that results from an *activating* mutation of the calcium sensing receptor in the kidney. So the kidney thinks you have too much serum calcium when in reality you don't. (Get ↓ PTH as a response) *Asymptomatic hypOcalcemia*

Familial Benign Hypocalcemia

pseudohypoparathyroidism results from an deficiency of _____. This results is multiple hormone resistance (not just PTH)

Gαs subunit

If a patient has: ↑ Ca2+ ↓PTH *↑PTH-rp* ↑ urine calcium ↓ phosphorus normal 1,25vitD think....

Humoral hypercalcemia of malignancy

_____ is systemic issue, where PTH-relatide peptide seen in *solid tumors* is secreted, causing *low PTH* hypercalcemia

Humoral hypercalcemia of malignancy

_______ is a therapeutic agent that binds to receptors on osteoclasts to reduce osteoclast activity. These have a very weak effect, due to tachyphylaxis.

Intranasal calcitonin

Hyperthyroidism, adrenal insufficiency, and pheochromocytoma are all endocrinopathies that cause hypercalcemia and a ___low/high PTH

LOW PTH

If a patient has: ↑ Ca2+ ↓PTH *↓PTH-rp* think....

Local osteolytic bone metastasis

_______ is a malignant cause of hypercalcemia via bone mets that cause bone lesions. The lesions, or destroyed bone, will leech Ca2+ out into the blood. Seen a lot in multiple myeloma and breast cancer

Local osteolytic bone metastasis

4-gland parathyroid adenoma involvement causing primary hyperPTH is associated with _____

MENI, MENIIA

In the proximal tubule of the kidney, calcium reabsorption is dependent on ____, not PTH

Na+ reabsorption and volume status

most common cause of primary hyperPTH is _____, causing elevated PTH levels

ONE (solitary) parathyroid adenoma

_______ is an enzyme inhibitor that decreases bone resorption and increases BMD. This is an oral drug, but is not yet FDA approved.....

Odanacatib (cathepsin K inhibitor)

Humoral hypercalcemia of malignancy is mediated by _____

PTH-relatide peptide

_____ sign is when you put a BP cuff on a patient, pump it up, and you elicit a carpal twitch. It is positive in patients with hypocalcemia

Trousseu's sign

Most of our vitamin D comes from the skin, produced via _____

UV radiation

treatment for ACUTE hypercalcemia

VOLUME repletion! (if bad, add a loop diuretic to increase calcium excretion from the kidney)

Fracture incidences in people with osteoporosis increase with ____

age

bone involvement of pseudo hypoparathyroidism is called _____, and includes rounded face and short 4th and 5th metacarpals

albright's hereditary osteodystrophy

Adjusted calcium is used to adjust for fluctuations in _____

albumin

Although not clinically available yet, _____ antibody is a therapy that aims to reduce the inhibition on Wnt signaling, allowing increased osteoblast activity

anti-sclerostin (romosozumab)

If a patients hypercalcemia is a result of a malignancy, you can use _______ to inhibit osteoclast bone resorption. It takes 2-4 days for full effect, to supplement with calcitonin

bisphosphonates

Fracture risk of patients with osteoporosis can be predicted using ______

bone mineral density and age

While a minor role _____, produced by C-cells in the thyroid, have negative affect of bone resorption and calcium release

calcitonin

_______ inhibit osteoclast action acutely, but due to tachyphalaxis, the therapeutic effect is short-lived

calcitonin

_____ deposits can cause cataracts and basal ganglia calcification in patients with low serum calcium

calcium

In a patient with familial benign hypocalcemia, do NOT try to normal calcium with _______, because you will induce hypercalciuria and renal insufficiency

calcium and vitamin D supplements

_____ is a really expensive calcium sensor agonist drug that will increase calcium excretion from the kidney. It is used for symptomatic patients who are poor surgical candidates

cinacalcet

Increased blood transfusions can cause in increased amount of ______, resulting in hypocalcemia

citrate

_____ is a monoclonal antibody that increases bone density, decreases bone turnober, and decreases fracture risk. It is administered subQ every 6months.

denosumab (anti-RANKL)

The _________ part of the kidney is the only one that is PTH depending

distal tubule

With low calcium, it will be ____(easier/harder)__ to elicit an action potential.

easier. You will have increased neuromuscular excitability

(T/F) vibration as a mechanical stimulus to stimulate bone growth is suggested.

false....

Bariactic surgery or intestinal/pancreatic disease can cause vitamin D deficiency because you have impaired ____ absorption

fat soluble vitamin

In acute stress release of ____ into the blood can bind to serum calcium, causing hypocalcemia

fatty acids

Severe osteoporosis is a T-score of -2.5 of lower plus ____

fragility fracture history

in patients with increase 1-hydroxylase activity, you can give _____ to decrease the enzyme's activity

glucocorticoids

In classic vitamin D deficiency, the first thing impaired is _______, which leads to hypocalcemia, and increased PTH (secondary hyperparathyroidism) and *decreased phosphorus*

gut calcium absorption

If you have acidosis, you will have __(↑↓)__ ionized calcium.

higher

The lower your BMD, the ___↑↓___ your fracture risk

higher

_____ are the most serious consequence from osteoporosis, severing limited social functioning of patients.

hip fractures

symptoms of: GI: consipation, anorexia, n/v, dyspepsia, PUD, pancreatitis CNS: lethargy>>coma Neuromuscular: weakness, hypotonia Heart: Short QT, arrythmia Renal: polyuria, stones, neurocalcinosis Musculoskeletal: myalgia Bone: osteoporosis are all symptoms associated with ____calcemia

hyPERcalcemia

In grnaulomatous diseases, will you see hypercalciuria or hypercalcemia first?

hypercalcuria

With alkalosis, you compensate with _____ (respiratory)

hyperventalation

PTH works at the kidneys by _____

increasing distal tubule Ca2+ reabsorption

Humoral hypercalcemia of malignancy __(is/is not)___ related to bone metastasis

is NOT

Calcium-sensing receptors located in the _____ act independently of PTH secretion (depending on serum calcium) to control calcium excretion.

kidney

If vitamin D deficiency is from reduced 1-hydroxylase activity, the enzyme issues precipitated from ______ issue.

kidney failure

Most common symptom of hyperPTH is ______

kidney stone

Patients with hypoparathyroidism have increased risk for kidney _____, since there is increase urine calcium excretion

kidney stones, nephrocalcinosis

_____ is a bipolar drug that can increase the setpoint for PTH secretion

lithium

BMP is a potential therapy for osteoporosis, but since it is non-specific, it is only used today _____

locally, at the site of a fracture, to promote its healing

_________ diuretics will increase urinary calcium EXCRETION by inhibiting calcium reabsorption.

loop diuretics (furosemide)

Calcium-sensing receptors in the kidney are located specifically in the ______, and are PTH independent

loop of henle

Osteomalacia, primary hyperparathryoidism, and myeloma can cause ___↑↓____ bone density

low bone density (low bone density is NOT just osteoporosis)

If you have alkalosis, you will have __(↑↓)__ ionized calcium.

lowered

_______ is an essential cofactor needed for ATPase function to produce and secrete PTH.

magnesium

_______ causes hypercalcemia and low PTH from exogenous source of calcium.

milk-alkali syndrome

PTH-relatide peptide does not affect 1-hydroxylase, so while the peptide will cause low PTH, this enzyme activity will be ____

normal

________ is a collagen disorder resulting in abnormal bone mineralization that can cause osteoporosis

osteogenesis inperfecta

______ is poor bone mineralization that results in diminished bone strength, and increased insufficiency fractures

osteomalacia (blue is calcification...not enough blue)

Fracture, loss of vertebral height, and low bone mass are diagnostic of _____

osteoporosis

Hypogonadism, glucocorticoid excess, decreased calcium absorption, immobilization, post-transplant, thyroid hormone excess, renal hypercalciuria are all secondary causes of _____

osteoporosis

______ is a skeletal disorder characterized by compromised bone strength, predisposing patient to fracture.

osteoporosis

kyphosis, hip fractures, and vertebral fractures are noted in the progression of _____

osteoporosis

Teriparatide (PTH) for therapeutic use of osteoporosis has a black box warning for ____, so the therapy is limited to 2yrs, and limited to very high risk patients with severe osteoporosis

osteosarcoma

If a patient with primary hypoparathyroidism is particularly difficult to manage, you can give them ______

parathyroid hormone (rhPTH) but it is not the first line choice

A person with labs that show ↑ Ca2+ ↓ phosphorus ↑ PTH ↑1,25 ↑ urinary calcium excretion think...

primary hyperPTH

______ causes low PTH, low calcium, increased phosphorous, and *↑ urinary cAMP after PTH injection*

primary hypoparathyroidism

parathyroid destruction (surgery, autoimmune) can cause _____

primary hypoparathyroidism

Neuromuscular excitability associated with hypocalcemia can cause ______, cardio issue

prolonged QT interval

________ is a disorder where you have normal feedback loops, but RESISTANCE to PTH. So while you have decreased calcium levels and increased phosphorus and *increased PTH* and after PTH infusion will have *low urine cAMP*

pseudohypoparathyroidism

If a patient has Gαs deficiency (as in pseudohypoparathyroidism) and the associated bone abnormalities, but NO hypocalcemia, this is called______

pseudopseudohypoparathyroidism

______ is a estrogeon receptor modulator, and while its shows to increase BMD, it has no effect on reducing fractures. (but does ↓ risk of ER+ breast cancer...)

raloxifene

_____ is when the kidney cannot do its job anymore. You INITIALLY get decreased excretion of phosphorous. This will initiate the FGF-23 feedback loop, decreasing 1,25vitD, increasing PTH, which will increase bone resorption for more calcium

renal failure

Unlike primary hypoparathyroidism, _____ treatment with NOT work for pseudo hypoparathyroidism, because patients have a PTH resistance.

rhPTH (artificial PTH)

_____ is osteomalacia in kids, causing bowed legs

rickets

PTH works at the bone by ____

stimulating bone resorption to release calcium from the bone into the blood

Bone ____ is comprised of many factors, including bone mass, architecture, turnoever, damage accumulation, and material properties

strength (note the decrease of architecture-struts-in the bone)

_______ is interestingly enough being used for osteoporosis, because rat models show that continue secretion of it will activate osteoclast activity, BUT a short burst of this will actually increase osteoblast activity

teriparatide (PTH!)

In vitamin D mediated hypercalcemia, the main source of calcium is from _____

the GI tract

90% of total body calcium is located in _____

the skeleton

_____ diuretics decrease sodium reabsorption which will increase calcium REABSORPTION. This is a good treatment for patient with Hx of kidney stones

thiazide diuretics

_____ is a diuretic that could lower urine calcium in hypoparathyroid paitents

thiazide diuretics

(T/F) hypercalcemia will cause volume depletion.

true....hypercalcemia causes increased kindney calcium/water excretion (diuresis), leading to volume depletion

_______ is a mesenchymal tumor that produces FGF-23, increasing calcium excretion and causing low bone mineralization

tumor-induced ostemalacia (TIO)

What is the distinguishing lab value between primary hyperPTH and FHH

urine calcium for primary hyperPTH, urine calcium is high (increased secretion by kidney for FHH, the kidney does not respond to PTH levels, so urine calcium excretion is low

Sunlight deprivation, and poor diet can cause _______ deficiency

vitamin D

To treat hypoparathyroidism, you can give high dose of ______ precursor and active metabolite. You do not have to worry about feedback, because there is not PTH

vitamin D (both vitamin D and 1,25 D)

If a patient has: ↑ca2+ ↑ phosphorus ↓PTH *↑↑ 25 (OH2) vitamin D* markedly elevated urine calcium think...

vitamin D toxicity

________ is caused by long-term excessive use of vitamin D.

vitamin D toxicity

______ is when a patient has normal levels of FGF-23, but it is degraded slower than normal. Therefore, it stays around and has effects longer, increasing calcium excretion and causing low bone mineralization

x-linked hypophosphatemic rickets (XLH)

(T/F) Magnesium deficiency can cause hypocalcemia

yes

(T/F) estrogen is a good possible treatment option for primary prevention.

you would think true.....but FALSE! while studies did show that estrogen reduced fractures, there was an increased of associated adverse events - like strokes and pulmonary emboli - that make estrogen not efficacious

with hypoparathyroidism, you will have ___(↑↓)___ urinary excretion of Calcium

↑ excretion, because low PTH signals means there is no signal to increase serum calcium


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