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Endocrine Week 4 2017/18 > 10: Disorders of calcium metabolism > Flashcards

10: Disorders of calcium metabolism Flashcards

1
Q

Which chemicals increase blood calcium?

A

PTH

Vitamin D

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2
Q

How do blood calcium levels increase?

A

Absorption from gut

Moves from bone to blood

Reabsorption from kidneys

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3
Q

How is calcium excreted?

A

Kidneys

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4
Q

Which gland regulates calcium concentration?

A

Parathyroid gland

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5
Q

Which receptors on parathyroid glands sense calcium concentration?

A

Calcium sensing receptors

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6
Q

How is Vitamin D obtained?

A

Diet (oily fish, red meat and eggs)

Sunlight

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7
Q

What is the mnemonic for hypercalcaemia symptoms?

A

Stones (renal stones)

Bones (osteoporosis)

Groans (abdominal pain)

Psychic moans (depression)

add on polydipsia and polyuria as well

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8
Q

What are the acute symptoms of hypercalcaemia?

A

Polydipsia

Polyuria

Confusion

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9
Q

What is seen in chronic hypercalcaemia?

A

Myopathy

Osteoporosis > Fragility fracture

Hypertension

Abdo pain - pancreatitis, ulcers, kidney stones

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10
Q

What is measured to diagnose hypercalcaemia itself?

A

Serum calcium

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11
Q

What are the two most common causes of hypercalcaemia?

A

Primary hyperparathyroidism

Malignancy

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12
Q

Which drugs cause hypercalcaemia?

A

Vit D - causes inc. calcium absorption, reabsorption and transfer from bones

Thiazide diuretics - increase calcium reabsorption from kidneys

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13
Q

Which granulomatous diseases can cause hypercalcaemia?

A

Sarcoidosis

TB

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14
Q

(High / low) bone turnover causes hypercalcaemia.

A

High bone turnover

so diseases like Paget’s

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15
Q

Which tests are done to diagnose hyperparathyroidism?

A

Raised serum calcium

Raised PTH (or inappropriately normal for Ca levels)

Increased urine calcium secretion

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16
Q

How does malignancy cause hypercalcaemia?

A

Bone destruction

PTHomas

Inflammatory factors activate osteoclasts

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17
Q

Which liver enzyme will be elevated in hypercalcaemia secondary to malignancy?

A

ALP

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18
Q

How is suspected malignancy investigated?

A

Imaging - X-ray, CT, MRI

Nuclear imaging - isotope bone scan

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19
Q

How is hypercalcaemia treated?

A

Fluid resuscitation if dehydrated

LOOP diuretics (thiazides cause hypercalcaemia)

Bisphosphonates to reduce osteoclast activity

If granulomatous disease, steroids

20
Q

Which type of scan is used to view the activity of the thyroid and parathyroid together?

A

Sestamibi scan

21
Q

What is the only definitive treatment for hyperparathyroidism?

A

Surgery

i.e parathyroidectomy

22
Q

If surgery isn’t appropriate, how is hyperparathyroidism treated?

A

No treatment available

23
Q

What are some complications of hyperparathyroidism?

A

Bone disease inc. osteoporosis BONES

Peptic ulcers GROANS

Renal stones STONES

Depression PSYCHIC MOANS

24
Q

What is primary hyperparathyroidism?

Which PTH and Ca levels would you see?

A

Overactivity of parathyroids due to adenoma/carcinoma or hyperplasia

Raised PTH, raised Ca

25
Q

Which genetic syndromes are associated with primary hyperparathyroidism?

A

MEN-1, MEN-2A

causing parathyroid tumours which secrete TSH, leading to hypercalcaemia

26
Q

What is secondary hyperparathyroidism?

Which PTH and Ca levels would you see?

A

Physiological response to low calcium levels e.g in chronic kidney failure

Low Ca, raised PTH

27
Q

What is tertiary hyperparathyroidism?

Which PTH and Ca levels would you see?

A

Autonomous parathyroids after years of secondary

Ca raised, PTH raised

28
Q

Why must you check urinary calcium levels as well as blood calcium when diagnosing hypercalcaemia??

A

Hypercalcaemia w/ low urinary excretion of calcium indicates FAMILIAL HYPOCALCIURIC HYPERCALCAEMIA, a genetic condition

29
Q

What is the problem in hypocalciuric hypercalcaemia?

A

Calcium sensing receptor on parathyroid gland has higher set point for calcium

So higher Ca conc. required before PTH is switched off

30
Q

What are the symptoms of hypocalcaemia?

A

Paraesthesia

Muscle pain, tetany and weakness

31
Q

What PTH level is seen in hypocalcaemia?

A

High PTH level

32
Q

What are two physical signs of hypocalcaemia?

A

Chovstek’s sign - tapping on the parotid gland causes mouth to twitch

Trousseau’s sign - inflating BP cuff causes wrist and finger flexion

33
Q

What is an ECG sign of hypocalcaemia?

A

Prolonged QT interval

34
Q

What causes hypocalcaemia?

A

Hypoparathyroidism

Vitamin D deficiency (causing osteomalacia/Rickets)

Chronic renal failure

35
Q

How is acute hypocalcaemia treated?

A

IV calcium

36
Q

Which congenital syndrome causes hypoparathyroidism?

A

DiGeorge syndrome

invariably causes absent parathyroids

37
Q

Deficiencies in which two chemicals can cause hypoparathyroidism?

A

Vitamin D

Magnesium (causing hypoparathyroidism > hypocalcaemia)

38
Q

What usually causes hypoparathyroidism?

A

Destruction / removal of parathyroids

39
Q

How is hypocalcaemia managed long-term?

A

Calcium, Vitamin D supplements

40
Q

Which ion is required to release calcium from cells?

41
Q

What name is given to hypocalcaemia in which PTH is high?

A

Pseudohypoparathyroidism

42
Q

What causes pseudohypoparathyroidism?

A

Genetic mutation causing PTH resistance rather than failure to produce PTH

43
Q

Which bone diseases are caused by Vitamin D deficiency?

Which bone diseases can be caused by (amongst other things) calcium and phosphate deficiency?

A

Rickets / Osteomalacia

Osteoporosis

44
Q

What causes Vitamin D deficiency?

A

Lack of Vitamin D in diet

Malabsorption

Renal failure

Lack of sunlight

45
Q

Chronic renal failure causes a ___ _ deficiency leading to which kind of hypoparathyroidism?

A

Vitamin D

secondary

46
Q

Patients with osteomalacia / Rickets who are given Vitamin D supplements may not respond - why?

A

X-linked hypophosphataemia

Endocrine Week 4 2017/18 (10 decks)

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