30 D.) MJ and her dad returned from the radiology department just about the same

Question

30 D.) MJ and her dad returned from the radiology department just about the same time the lab results were available. As expected, the labs indicated that her renal function was abnormal. Some additional labs reported that her blood calcium ion level was below normal, and her blood phosphorus level was elevated. These labs were a bit worse than the report they had received from the university nephrology service six weeks ago. While there were other possible causes for these lab findings, putting all the available information together suggested that MJ's bone pain might be caused by renal osteodystrophy (ROD). A diagnosis could be confirmed when lab results for levels of vitamin D and parathyroid hormone came back.

The resident left the family in the room to try and contact MJ's nephrologist. She was able to contact a first-year medical intern who had met MJ's family at the appointment six weeks earlier. He had given them the bad news about her condition, and the information that they would need to return in eight weeks to begin arrangements for dialysis and even a possible kidney transplant. He asked the resident if she had ordered blood tests for the levels of growth hormone and parathyroid hormone. The intern would need to discuss his findings with the attending physician, but he was confident that he would want her transferred to their service. The orthopedic resident returned to the room to discuss her phone conversation, the lab findings, and the possibility that MJ would be transferred to the university hospital. In response to the resident's questions, MJ's parents replied that they had not realized that her symptoms were related to her kidney disease. MJ's dad, having missed the previous conversation about bone growth, wanted to know what could happen to MJ as her skeleton matured.

MJ will reach puberty in a few years. At that time, the amount of estrogen in her body will dramatically increase. Which of the following statements describes the effects of estrogen on appositional and longitudinal bone growth?

a. Testosterone has a more potent effect on epiphyseal plate closure than estrogen, which would primarily affect appositional growth. This is explains why men are somewhat taller than women on average. b, Estrogen increases the rate of appositional bone growth by inhibiting osteoblast activity. c. Estrogen has a more potent effect on epiphyseal plate closure than testosterone which explains why men are somewhat taller than women on average. d. Estrogen increases the rate of longitudinal bone growth by accelerating osteoclast activity.

Explanation / Answer

C. Estrogen has a more potent effect on epiphyseal plate closure through ER alpha & ER beta receptors mediated by Growth hormone & IGF-1. This effect is more prominent than testosterone which explains why men are somewhat taller than women on average.

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