Grumpy Old Man - Case Study

1. Ernest’s abnormal blood calcium levels indicate there may be a problem with a particular endocrine gland. Which gland is the doctor likely concerned about? Where is it located? The gland the doctor is likely worried about is the Parathyroid gland. The Parathyroid gland is located behind the thyroid gland inside the body at the base of the neck. 2. Calcium is crucial for the proper function of a number of body systems, so blood levels must be tightly controlled. Predict the three body systems that are most affected by abnormal calcium. The skeletal system will be affected as bones need calcium for support, to store within the body, and bone mineralization. The muscular system also needs calcium to be able to contract muscles. Lastly, the nervous system needs calcium for the regulation of nerves and how they conduct impulses. 3. What is PTH? What is its function and how does it carry out that function? PTH is the Parathyroid hormone. PTH controls how calcium is released, absorbed, and stored and is released from the Parathyroid when calcium levels are not at normal levels within the body. 4. Use your text or websites to find the normal range of blood (serum) calcium in adults (express your answer in mg/dL). 8.5 to 10.2 mg/dL Are Ernest’s calcium levels of 11.8 mg/dL and 11.3 mg/dL too high (a condition known as hypercalcemia) or too low (hypocalcemia)? Ernest’s calcium levels are too high. Hypercalcemia. Based on Ernest’s calcium levels, draw and explain a homeostatic feedback loop that shows what should normally happen between calcium levels, the PTH-secreting gland, and PTH levels. Calcium levels decrease - Kidneys monitor calcium levels - Parathyroid releases PTH - Calcium levels regulate. Assume that Ernest’s PTH-secreting gland is not functioning as it should. Based on your answer regarding his calcium levels in part (b), predict whether his PTH levels are likely to be increased or decreased. Explain your answer (include a feedback loop). Ernest’s PTH levels are likely to be decreased with help of treatment to restore his calcium levels to a normal range. Parathyroid releases high PTH due to hypothyroidism - Calcium levels too high Intravenous bisphosphonates - PTH levels restored back to normal - Calcium restored to normal range Suppose the patient in the adjacent ER bed had a calcium level of 10.1 mg/dL and normal gland function. How would her PTH level compare to Ernest’s? Explain your answer. The other patient’s PTH levels are 1.7 mg/dL lower than Ernest’s. While they are only slightly different from each other the other patient’s PTH levels are considered to be on the high side of the range while Ernest’s are considered to be in Hypercalcemia. What might you conclude if Ernest’s PTH levels are within normal limits (not too high and not too low)? Explain your answer If Ernest’s PTH levels lower to be within the normal range he would not be in Hypercalcemia. His Parathyroid would be working correctly to correct the high calcium levels within his body. 5. Given your answer to question 4(d), research the typical signs and symptoms you might observe in a patient who has PTH levels like Ernest. Which of these does he exhibit? Predict how the abnormal gland activity could be related to his signs and symptoms. Ernest exhibited Joint pain, bone pain, fatigue, muscle aches, weakness, constipation, depression, and bone thinning. The abnormal gland activity affected his skeletal system, digestive system, and nervous system. The skeletal system had too much calcium causing the bones to become brittle and less dense, the digestive system had too much calcium to process thus causing constipation, and the muscular system that uses calcium to contract smooth muscles wasn’t able to do it properly causing pain and mental issues. 6. If the doctor’s suspicions are correct, what is the most common method of treating Ernest’s condition? What are the potential risks or side effects? The first line method for treating Ernest’s condition would be intravenous bisphosphonates and continued treatment with oral bisphosphonates or in rare cases require a parathyroidectomy to restore normal PTH levels. The potential risk of bisphosphonates can be jaw osteonecrosis, upper GI adverse affects, joint pain, feeling sick, flu like symptoms, fever, etc.