Endocrinology - Calcium and Phosphate Regulation

[@MelbourneMaster]

If you're looking for a few extra steps and more in-dept: The precursers of vit D comes from foods (like oily fish; D3), plants (D2) and the sun D3. In the skin the suns UV-rays converts 7-dehydrocholesterol into cholecalciferol D3 (done non-enzymatically by heat). Cholecalciferol then moves into the liver (transported from the skin by vitamin D-binding-protein (DBP), and by cholemicrons from the diet) for the first part of its activation. Here it is converted by the enzyme (cytochrome P-450-based enzyme) into 25-hydroxy vit D3 (25-OH-D) (calcidiol) the step is called 25-hydroxylation, it then moves to the kidney for its second and last activation. Here the 25-OH-D/DBP complex is taken up at the surface by renal proximal cells by a specific mechanism involving cell surface receptors; megalin and cubulin. In the kidney 25-OH-D is converted to 1,25 dihydroxy vit D (1,25-(OH)2D) (calcitriol) by renal-1α-hydroxylase - this activation is called 1α-hydroxylation (patients with renal failure therefore cannot perform this step). The 1α-hydroxylase comprises 3 proteins: Cyt P-450, a ferredoxin and a ferredoxin reductase for activity. 1α-hydroxylase is strongly downregulated by 1,25-(OH)2D (calcitriol) and strongly upregulated by PTH as a calcium homeostatic loop.

[@pearlalmeida3541]

O.

[@KeirDickson706]

This video just taught me more in 11 minutes than my lecturer has in like 235 powerpoint slides :))))))) ur the best

[@user-dd4vo3ik6n]

Exactly 👌🏻

[@kingbobbie5196]

Asweer chale 😂

[@kingbobbie5196]

U dey UG?

[@KeirDickson706]

@@kingbobbie5196 ye

[@kingbobbie5196]

Oh nice... which year?

[@aboutmedicine]

I think its worth mentioning phosphate doesn't need Vitamin D for uptake from the diet. This is part of the reason why in chronic kidney disease, you have low serum calcium but high serum phosphate. The kidney can't make Vitamin D if its diseased, so calcium uptake is not enough, but phosphate can still get across from the intestines into the blood. Cheers Armando you rock by the way : )

[@samuelbenson1]

CKD - Decreased GFR, Kidney cannot excrete enough phosphate, phosphate increases FGF-23 which blocks 1-alpha-hydoxylase. Decrease Calcitriol, decrease intestinal absorption of ca and phosphate, yet kidney cannot excrete enough phosphate so phosphate remains high and binds free calcium. Decreased calcium stimulates increase in PTH, PTH increases bone turnover, leads to metabolic bone disease, pt over time has bone pain, fractures. PTH normally stimulates kidney to lose phosphate, but decreased GFR and kidney injury causes phosphate to not be excreted.

[@zaman54321]

I was looking for this. Thank you so much.

[@pilatesyogataichifit]

Anything apart from kidney disease that causes low serum calcium and high serum phosphate?

[@kelseymcginnis5673]

ahh thank you!

[@Dandandandandy]

@@samuelbenson1 saved my life thank you!

[@adnanbashi9793]

You forgot to mention that PTH reduces the reabsorption of phosphate from the proximal tubule of the kidney, which means more phosphate is excreted through the urine!

[@nurkoleptik_art]

Adnan Bashi I think he included that in one of his older videos which is the "bonehomeostasis (calcium phosphate) hormones" video :D

[@bihishtasozan1903]

exactly what i was confused about okay so i did understand the concept

[@nellyhoffman6194]

Thanks adnan

[@cescrosado]

Adnan Bashi that's the fosfaturic action of PTH, exactly!! On the other hand, calcitriol does not do that treating equally calcium and phosphate (reabsobring both of them, PTH only reabsorbed calcium) and so, if there's an excess of calcitriol (vit D), they can precipitate.

[@tonyboroni6949]

not true i have both high phosphate and pth with low low t4 wich i take meds for but nothing i can do for my pth issues so im fct, this condition was missed for years now i have perment bone and liver problems now and heart racing issues.

[@zeynepecearslan4000]

what would i do in med school without your videos

[@lientranthi2261]

Zeynep Ece Arslan Tra

[@aleksandarjoe4290]

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[@windiandini6919]

trueee

[@obviouslytwo4u]

go vegan and work it out for yourself

[@cristymendez9385]

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[@Partycornchips]

I just love this guys handwriting. It's so regular and consistent.

[@33bien]

yes he is great writer and draws beatifully

[@desifeminism4576]

Truuuuuuuu

[@Nina21_]

this is truly an amazing explanation in a short amount of time compared to long complicated lectures ! thank you so much sir

[@langeo.2383]

when he is more of an artist and a scientist combined in one human entity... Respect Boss...

[@Unknown-ft6wz]

1 to 2 hours lecture in just 11 minutes... Thanx a lot....🥰

[@FlyingPiesOmg]

your endocrinology videos are second to none, great job!

[@panashechitsike1236]

you are such a lifesaver. this was so clear. cleared a lot of confusion I had on the main hormone that controls bone growth and remodeling. keep up the great work! looking forward to more of your work.

[@sarasultana9804]

You've got some wonderful content in here!!! I discovered this channel a few weeks ago and my whole study game has changed ever since! Thank you so much @armandohasudungan

[@angelarebelo166]

i had an eyegasm while watching this, also your accent is so good!! tysm for this, i search everywhere for a good video about calcium homeostasis and here i am. tysm for explaining it this way. also, the drawings, i loved them!! thank you thank you

[@chrisland97]

I'm studying this stuff and it's great to see it in easy to see pictures and descriptions/words. And you have pretty impressive hand skills!

[@dominiquelee3923]

You have a gift of teaching! Your videos are so clear and easy to comprehend! THANK YOU!!!!!!!!

[@bushrakhalid7688]

This is so amazing, I don't know why I couldn't find it before, but it's really very helpful , Thank you 😊😊

[@johndytiapco7817]

OH MY GOD, I LOVE YOU DUDE, U MADE THIS CONCEPT SO EASY TO LEARN

[@rajeshreggie2396]

Thank you very much , after i watched this video i felt ur the best teacher who can ever exist. you made it soooooooo easy to understand

[@fiza5403]

Honestly thought this was animated till looking closer, props to ur drawings and hard work

[@samuelbenson1]

Awesome! Better than any class in Medical School.

[@__h629]

videos like this in youtube became my teachers in online class.. I shouldn't enroll in school 😂.. I should enroll in youtube😂

[@محمودجمال-ب4ت]

Brief, clear, and knowledgeable. Keep up the good work.

[@nisakutluay4931]

It could not be explained better than this 👏🏻

[@bunyigechacha5280]

A lot of Love from Kenya♥️🇰🇪

[@abrahamkinsmanamoakoh4077]

Thank you so much for the presentation and more importantly having a camera focus on all the drawings and labels at the end of the presentation. It helps a lot

[@annaso6747]

Beyond helpful!! Didn't realize I was a visual learner until I stumbled upon your videos and everything clicked into place! Thank you so much :))

[@ashitabhasin8434]

This video is amazing...i mean i was about to spend 3 hrs on this metabolism now with this video in just 20 min i gain all concept regarding ca metabolism ...thanks...thanks alot

[@yogeshgondalia5676]

This video is a great way to recap physiology of Ca2+. Pictures help alot. Thanks!

[@himanshusisodiya6022]

I just cant tell how happy i m to find ur channel

[@iSisiblog]

Thank you so much! Clear and easy to understand - I really loved it!

[@methanogenthenasty9183]

Screenshot at 11:14

[@ruigomesxp]

I mean, after watching so many of your videos I must thank you for all your effort to put this out there. I know that you get revenue from this and that all video images are outsourced from an artist that works in partnership with you, but that does not take any merit from it. Huge Thank you

[@zeshanansari8720]

Possible Correction: I may be wrong about this but after some researching, I found that C-FMS you mentioned on osteoclast is actually the gene that encodes CSFR-1 which is the receptor on osteoclast. If someone else could also research and confirm or deny this, that would be great! Thanks! Your videos are awesome!

[@irineandrona7948]

You and ninja nerd have saved my LIFE !!!!

[@ManpreetKaur-wh6rw]

Tanks sir...without this vedio i can't to do anything....in my endocrinlogy thanks

[@captincibaihi6059]

I was born 7 days before this video came out. After 17 years and 9 days, here I am studying for this for my exam in 2 days hahaha.

[@sarajohn1215]

Thank you for this video😭🙏🏻

[@tilak231]

Came here for Rank Ligand actvt and did a quick review of The 3 hormones!! Thanks a lot! ✊

[@emmalynjimenez5422]

Thank you..i understand it even better than reading books or in class😅...Gracias❤

[@barbrauwaifo6941]

Everything about your videos are perfect

[@rehpotsirhc21]

This just further reassured me my body is messed up and why my doctor is even confused.

[@dennis.zinner]

definitely very helpful for my upcoming nutritional physiology exam!

[@skyassil7689]

although my studies are in French but this explanation was very helpful.. Thank U Mr. Armando /big hi from Algeria :)/

[@ademanou4708]

thank you man ! your videos are really helpful for us med students keep up the good work 😁😁

[@mich12346]

You help me pass nursing school! Thank you

[@686afroman]

Hello Armando, I came here because I needed to understand how do interact Calcium levels, vitamin D and PTH, because I have multiple sclerosis and I’m following a therapy called Coimbra Protocol, which is based in a few pillars: - Ultra high Dosis of vitamin D3 (50.000 units in my case to set my immune system back to “default”) - Very low calcium diet (to avoid to much calcium to filter) - More than 2,5 L of liquids per day (to avoid high concentration in Urine) - Regular sport (to build bone tissue up) - Avoid stress and unhealthy food My question is, why, when a low level of Calcium in blood stimulates the production, did my PTH level increased from 21 pg/ml to 31? The second time I checked this value, it only increased from 19,5 to 21 in the same time frame. I ate a bit more calcium-rich food in this time, so my body should have absorbed way more calcium. I just don’t get it A video about the coimbra protocol, how it works and what are its dangers, would be really nice :)

[@lucecita007]

Porque lo que tienes es un tumor en las glándulas paratiroideas. O varios tumores. Hay que sacarlos y ya no te enfermas

[@MrDjhume]

This is amazing - thanks for helping me decipher Ca/Mg/P regulation for my second year med school course :)

[@DrHistoryV]

+David John Hume helped me in physiology first year too

[@lauralucy1]

Absolutely fantastic! I get it! Big thanks from Ireland ☘️👍🏻☘️

[@shivanagpal1163]

Sir no words in your praise....🙏 Thanks a lot😊

[@ubongumoren1856]

This is just too good! Thank you very much and keep it up!!

[@ravulanikhileshwari2204]

This video helped me a lot,thank you very much.

[@bihishtasozan1903]

I thought PTH decreases re-absorption of phosphate ( increases excretion ) and increases re-absorption of Ca+ ( decreases excretion ) in the kidney > ?

[@freakzzz9821]

yes you are right! PTH increases the secretion of phosphate in the kidney and also increases retention of Ca2+ in the kidney. So Ca2+ lvls will rise and phosphate lvls will decrease, because otherwise they would form again a complex in which Ca2+ is not free so not excessable for the body needs. But be careful! PTH is just a short time response, long time regulation is the role of Vit. D3 and calcitonin. Hope that helped.

[@bihishtasozan1903]

Thank u !

[@AIStocksInsight]

Freakzzz strong med 😉

[@samphonnetgamgee5625]

There are mistakes in this.

[@thisbushnell2012]

facing possible parathyroidectomy after years of hyperparathyroidism (maybe my lifetime) and this is the FIRST explanation of the why of the many attempts over the years for the various 'treatments' tried to little avail. I've doubled my D3 intake, for starters, now that I understand its role.

[@maisoonazzam8830]

Amazing diagram and explanation. Bless you 🙏

[@cansuucar7898]

I can understand whats actually happening thanks to you. please upload more and more vidss

[@pushkarnigupta9609]

Explanation was awesome along with drawing 👍👌

[@Ali_r1999]

Brilliant, that's very helpful. I appreciate you

[@_sn0wbl00d]

What does this have to do with the skeletal system?

[@33bien]

Thank You! Finally a good explanation of the calcium system. I wonder why it is often claimed that one cannot feel when bone is decreasing or osteoporosis sets in. The acid that "eats" the bone due to the osteoclast activity must be painful. Acid/nerves=pain.

[@davisonmajazyo9469]

Armando is Heaven Sent! ☆☆☆☆☆

[@diviradicle]

You’ve saved me and my exam

[@mrbece9453]

I have one little critic point, I wonder because I found out that calcitriol doesn't effect the proximal but the distal tubules in the same manner as PTH. It leads to an increased synthesis & incorporation of EcaC-Ca2+ channels into the DCT which then take up the Ca2+ into the cells leading to increased Ca2+ reabsorption. EcaC channels are not part of PCT and I learned that regulation only takes place in the DCT. Please consider & if possible disprove my critics.

[@elenanora40]

You passed the test ! Now tell me how do we stop boneloss and regrow some bone back ??? Thank you !

[@khayyam3000]

Really enjoyed this video

[@محمودجمال-ب4ت]

Nice work. Keep on going.

[@jasminmehrabi4117]

amazingly well explained, thank you!

[@suzieajayi8424]

Excellently put together.Well done

[@dr.shandhanchowdhury3955]

Best Teacher

[@leak7161]

Great video Armando, love your drawings as well !

[@ahmedemad8386]

Thank you so much....you have made it like a piece of cake😊

[@WinkThatCouture]

@2:41 pretty sure phosphate levels in the serum are DECREASED due to PTH.

[@christinakakoulli1783]

Thank you soo much, that was incredibly helpful

[@sokhengung7983]

The best explanation ever 👏

[@sarahbrandao6028]

Perfect as usual.

[@avdheshsharma6346]

how would i Be Studying microbiology without your Videos< Make More..

[@evin_manjaly]

Nicely Drawing and Nice Class❣️

[@nancyg6205]

Bestest video ever

[@ridaasif6324]

Great! :) Please explain rapid and slow action of calcium homeostasis as well

[@User-to7nb]

We owe you so much man

[@BenjaminMoetlediwa]

Thank you sir

[@BakrAli10]

What about bone mineralization? I know it is done by osteoblasts, but, what factors increase the activity of osteoblast?

[@rinkytripathi6657]

Amazing video , thank you so much , waiting for new videos sir

[@MelbourneMaster]

Calcitonin has a very limited role to play in calcium homeostasis in adults. Its mostly prevalent in infants and children. In adults the "surface calcium-sensing recepters" located on the parathyroid gland sense changes in plasma calcium levels and inhibit PTH as you describe. This is the main major adjustement, calcitonin action is very very limited.

[@anamikakumar4814]

this was soooo helpful thank you so much!!

[@shahmirkhan8200]

Continue ur great work sir 🙂👍ur the best

[@ibrahimjouni3458]

thanks, very informative. PTH also reduces phosphate reabsorption by the proximal tubule, resulting in an enhanced excretion of phosphate in urine.

[@aimz_med]

Thanks ... that was very clear

[@JLa-mx5tg]

Quick question, if calcium in the blood serum is increased does that mean calcium in the bone is decreased?

[@ritikasehrawat4767]

This video is super awesome And has proved to be so much helpful to me. Thanks for this video.

[@Jjtt7]

just great work . thanks very much

[@biswajitdutta770]

Which means over secretion of parathyroid hormone weakens our bones....... wright?

[@asramohammadi9339]

Thanks for helping my lazy ass who bunked the classes of endocrinology with this simple kickass explanation. 👁️👄👁️

[@mahbubulalam2067]

U r just soo talented! I like your vedios very much. God bless u.

[@chucknorrislife]

Mr. Armando im having trouble grasping some of the functions of activated vitamin d3. While i do understand vitamin d3 main role is to absorb calcium and phosphate from the small intestines and acts similarly to pth in osteoblast proliferation and maturation I dont understand how it helps in calcium reabsorption from the proximal convoluted tubules. This is because from what i can understand all of calcium reabsorption in the proximal convoluted tubules occurs in a paracellular meaning it does not enter cells but passes between cells and it does not depend on hormonal action therefore activated vitamin does nothing in PCT, it is only by concentration gradients of Calcium and phosphate. and in your video you put that vitamin d regulates the PCT calcium phosphate absorption. Help me understand, thank you.

[@dr-asaa7445]

thanks aloooot ... you always help me on my medical study .. thanks again

[@emanhtth9830]

thanks soo much,am realy enjoyed

[@titilayooluwatosin5891]

Thank you so much.

[@yogayantra]

Hi Armando, you drew the pituitary gland, but did not mention anything about it. Thanks again for your videos

[@hawraaf6634]

THANK YOU for such an organized way Really helpful!!

[@usmanalimanj6840]

Add links of the image of the whole worksheet you draw on, in your description, so that we can print it later on. Thanks. Great work.