161b Ca/PTH/Bone path Flashcards
hypercalcemia - what test should be used?
PTH (along with Ca level)
hypercalcemia presentation
stones - nephrolithiases (+ polyuria)
bones - cortical bone, distal phalanges, salt and pepper skull
groans - constipation
psych overtones - depression, psychosis
hypercalcemia treatment?
hydration - Ca causes fluid loss loop diuretics (furosemide) calcitonin IV bisphosphonates glucocorticoids dialysis
primary hyperPTH?
most common cause of hyperCa
85% benign single adenoma, but can be carcinoma or hyperplasia x 4
primary hyperpth - clinical test results? Rx?
high PTH
high Ca - serum and urine
Rx - same as hyperCa
Calcimimetics (cinacalcet)
cinacalcet
calcimimetics
controls serum calcium, but doesn’t improve bone disease
sestamibi scan
radiolabeled tracer that finds hyperPTH for surgery
fmalilal hypocalcuria hypercalcemia (FHH)
AD - inactivation of CaR allele (just one allele)
body thinks less Ca so releases more PTH
low Ca in urine (<1% for ca:creatinine ratio)
Rx - observation
neonatal severe hyperPTH
AR
both CaR are bad –> high PTH and high Ca
bad
secondary hyper PTH?
approiatpe hihg PTH from low Ca from chronic renal failure or vit d deficiency
tertiary hyper PTH
long standing renal filure lead to autonomous PTH secretion
cancer and high Ca
1) PTHrP - binds PTH
2) tumors invade bone and produce osteolytic factors
3) ectopic production of active 1,25 Vit D
–> 1 a hydroylase
leukemia, lymphoma
hypocalcemia
most common cause is low albumin
measurement error (correct when albumin <4)
hypoCa featurs
neuromuscular irrability
faicial twiching with Chvostek’s
Trousseasu’s sign –> spasm of forehand and hand when occulded with blood p cuff
hypoPT
rare - due to surgery
DiGeorge syndrome
hypomagnesisemia
