Highlights
Case presentation
Frank is a 65-year-old man who presented to his GP reporting several months of fatigue, polyuria (abnormally large volumes of dilute urine) and constipation. Fank had a past medical history of depression, but no other remarkable conditions or history. His GP ran multiple tests, and Frank was eventually diagnosed with hyperparathyroidism and resultant osteoporosis.
Question
1. Briefly discuss what occurs in hyperparathyroidism, including potential causes and the impact on relevant hormones.
2. Discuss the process of mineralisation and remodeling in bones.
3. Explain the role of calcium in maintaining bone health and its influence on bone density.
4. Which hormone is primarily responsible for increasing the levels of calcium in the blood? Explain how this hormone increases blood calcium by acting on the bones, kidneys, and the intestines.
5. Discuss the role of hormones and vitamins involved in calcium regulation, and their interaction with each other. Describe how the feedback loop between these hormones works under normal conditions.
6. Investigate how hyperparathyroidism disrupts calcium homeostasis and impacts bone density and the risk of fractures.
7. Using the table below, identify which hormone (s) are not in their normal range. What endocrine organ is responsible for the imbalance(s). What would be the impact of these changes on calcium levels in the bone? Justify your answer.
|
Hormone |
Reference value/ range |
Patient value |
|
ACTH |
< 18> |
16.9 pmol/L |
|
Aldosterone |
<220> |
198 pmol/L |
|
Calcitonin |
< 50> |
73 ng/mL |
|
Insulin (overnight fast) |
43 – 186 pmol/L |
78 pmol/L |
|
Glucose (overnight fast) |
4.2 – 6.2 mmol/L |
5.8 mmol/L |
|
Thyroid stimulating hormone |
0.4-5 mUL/L |
0.8 mUL/L |
|
T3 |
1.1 – 2.9 nmol/L |
3.6 nmol/L |
|
T4 |
64 – 154 nmol/L |
181 nmol/L |
8. Briefly describe osteoporosis, and discuss how the risk of osteoporosis differs across sexes and age, describing some of the key factors that contribute to these differences.
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