Topic: Mechanism of action of hormones, formation, secretion, transport, metabolism, function and regulation of secretion of pancreas and pituitary gland.
Question: Discuss the mechanism of maintenance calcium homeostasis in the body. What are the clinical aspects of hypocalcemia.
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- Mechanism of maintenance of calcium homeostasis in the body:
Calcium homeostasis is maintained through a complex interplay of hormones, vitamins, and organ systems. The three main hormones involved in calcium homeostasis are parathyroid hormone (PTH), calcitriol (active form of vitamin D), and calcitonin.
- Parathyroid hormone (PTH): PTH is secreted by the parathyroid glands in response to low serum calcium levels. PTH increases serum calcium levels by stimulating bone resorption, increasing renal tubular reabsorption of calcium, and enhancing the activation of vitamin D.
- Calcitriol (active form of vitamin D): Calcitriol is produced in the kidneys from vitamin D and is responsible for increasing intestinal absorption of calcium and phosphorus. Calcitriol also promotes bone resorption and renal tubular reabsorption of calcium.
- Calcitonin: Calcitonin is secreted by the thyroid gland in response to high serum calcium levels. Calcitonin decreases serum calcium levels by inhibiting bone resorption and increasing renal excretion of calcium.
Other factors that play a role in calcium homeostasis include dietary intake of calcium and vitamin D, intestinal absorption of calcium, renal excretion of calcium, and bone metabolism.
- Clinical aspects of hypocalcemia:
Hypocalcemia is a condition characterized by low serum calcium levels (<8.5 mg/dL). The clinical manifestations of hypocalcemia can be variable and depend on the severity and duration of the calcium deficiency.
- Neuromuscular symptoms: Hypocalcemia can cause neuromuscular symptoms such as paresthesias (tingling or numbness), muscle cramps, and spasms. In severe cases, hypocalcemia can cause tetany, which is characterized by involuntary muscle contractions and spasms. Tetany can present as carpopedal spasm (spasm of the hand and wrist muscles), laryngospasm (spasm of the vocal cord muscles), or seizures.
- Cardiovascular symptoms: Hypocalcemia can cause cardiovascular symptoms such as prolonged QT interval on electrocardiogram (ECG), hypotension, and heart failure.
- Psychiatric symptoms: Hypocalcemia can cause psychiatric symptoms such as depression, anxiety, and confusion.
- Other symptoms: Hypocalcemia can cause other symptoms such as fatigue, weakness, and dry skin.
The causes of hypocalcemia can be divided into two main categories: decreased calcium intake or absorption, and increased calcium loss or sequestration.
- Decreased calcium intake or absorption: Causes of decreased calcium intake or absorption include vitamin D deficiency, malabsorption syndromes, and low dietary calcium intake.
- Increased calcium loss or sequestration: Causes of increased calcium loss or sequestration include hyperparathyroidism, hypomagnesemia, renal failure, and pancreatitis.
The diagnosis of hypocalcemia is based on serum calcium levels, and the underlying cause should be investigated and treated accordingly. Treatment of hypocalcemia depends on the severity and cause of the calcium deficiency and may include oral or intravenous calcium supplementation, vitamin D supplementation, and treatment of the underlying cause. In severe cases, hospitalization and monitoring of serum calcium levels may be necessary.
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