Parathyroid hormone
[Ref: AV6:chp10; WG21:chp21]
- Synthesized by chief cells in parathyroid gland
NB:
- Oxyphil cells in parathyroid gland
= unknown function
* ? generate chief cells
Metablism
Halflife < 10 minutes
Metabolized in liver, then excreted in kidney
Actions
- Increase [Ca2+]
* Act on bones to increase bone resorption (by stimulating osteoclasts via osteoblasts)
* Act on kidney to increase Ca2+ resorption (by increasing apical calcium channel in DCT)
- Phosphate excretion
* Act on kidney to decrease PO4 resorption in proximal tubule
- Increase formation of 1,25-dihydroxycholecalciferol
In the long term
- Stimulate both osteoblasts and osteoclasts
* At mildly elevated PTH level, increase bone growth
NB:
- PTH is elevated
--> Increased plasma [Ca2+]
--> Increased filtered load
- Even though Ca2+ resorption is increased in kidney
--> Urinary excretion of Ca2+ may actually increase overall
--> May offset a large portion of [Ca2+] increase
Receptors
3 different receptors
G-protein linked
Factors affecting PTH secretion
Factors increasing secretion
- Decreased [Ca2+]
--> Decreased tonic inhibition on PTH
--> Increase PTH
* Ca2+ acts directly on parathyroid gland via cell membrane Ca2+ receptor
* Negative feedback
* Main regulatory factor
- 1,25-Dihydroxycholecalciferol
* Directly inhibit PTH
Factors inhibiting secretion
- High phosphate level
* To increase excretion by stimulating capacity of parathyroid gland to secrete PTH
NB:
- Magnesium is needed for normal PTH secretion
* Permissive [WG21:p395]
* Low magnesium can lead to low PTH and thus low [Ca2+]
- Calcitriol has slower inhibitory effect on PTH
Other notes
- Low PTH leads to hypocalcemic tetany
* Phosphate may or may not increase
- Parathyroid-related protein (PTHrP)
* Binds to one of the PTH receptors as well
* Increase [Ca2+]
* Marked effect on growth and cartilage development in utero
* Responsible for 80% of the hypercalcemia of malignancy