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Year 2 > Bone physiology & disorders > Flashcards

Bone physiology & disorders Flashcards

1
Q

What is involved in calcium homeostasis?

A

Diet
Gut absorption
Vitamin D
Parathyroid hormone

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2
Q

What changes to gut absorption can affect calcium homeostasis?

A

Bowel pathology
Age
Hormones (pregnancy & lactation)

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3
Q

What changes to parathyroid hormone can affect calcium homeostasis?

A

Hyperparathyroidism
Hypoparathyroidism
Malignant hypercalcaemia (parathyroid hormone related protein)

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4
Q

What changes to vitamin D can affect calcium metabolism?

A 
Diet
Kidney problems
Liver problems 
UVB exposure
Drugs
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5
Q

Describe calcium homeostasis

A

When calcium binds to the calcium sensing receptors on the parathyroid glands it suppresses the secretion of parathyroid hormone

Low calcium >
Parathyroid hormone is secreted >
Parathyroid hormone acts on the bones and kidneys >
Parathyroid hormone stimulates bone reabsorption, calcium reabsorption in the kidney and absorption in the small intestine via vit D synthesis in the kidney

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6
Q

What effect does low vitamin D have on parathyroid hormone levels?

A

It causes them to increase

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7
Q

Describe vitamin D metabolism

A

Dehydrocholesterol > sunlight
Cholecalciferol (D3) > liver
25 OH vit D > kidneys
1,25 OH vit D > effects on gut and kidney absorption of calcium and increase in bone density

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8
Q

What are the acute and chronic symptoms of hypercalcaemia?

A

Acute - thirst, dehydration, confusion, polyuria

Chronic - myopathy, osteopenia, fractures, depression, hypertension, abdominal pain, constipation

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9
Q

In hypercalcaemia what are the possible causes of abdominal pain?

A

Pancreatitis
Ulcers
Renal stones

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10
Q

What is the phrase used to remember symptoms of hypercalcaemia?

A

Stones, groans, bones and psychic moans

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11
Q

Which investigations are indicated in syspected hypercalcaemia?

A 
Calcium 
Albumin
Parathyroid hormone 
Phosphate
Urine calcium
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12
Q

What would raised albumin and urea indicate?

A

Dehydration

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13
Q

What would raised albumin and normal urea indicate?

A

Cuffed blood sample

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14
Q

What would normal/low albumin, low PTH and high phosphate indicated?

A

Bone pathology

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15
Q

What would normal/low albumin, high PTH, low/normal phosphate and high urine calcium indicate?

A

Primary/tertiary hyperparathyroidism

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16
Q

What would normal/low albumin, high PTH, low/normal phosphate and low urine calcium indicate?

A

Familial hypocalciuric hypercalcaemia

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17
Q

Which test can you use to further assess bone pathology?

A

Alkaline phosphate

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18
Q

What does high alkaline phosphate in the context of the other investigations indicate?

A

Bone metastases
Sarcoidosis
Thyrotoxicosis

19
Q

What does low alkaline phosphate in the context of the other investigations indicate?

A

Myeloma
Vitamin D excess
Mild alkaline syndrome (thyrotoxicosis, sarcoidosis & raised bicarbonate)

20
Q

List some causes of hypercalcaemia?

A 
Primary hyperparathyroidism 
Malignancy 
Familial hypocalciuric hypercalcaemia 
Vitamin D
Thiazide diuretics 
Granulomatous disease (sarcoid, TB)
Turnover (bedridden, thyrotoxic, Paget's)
Tertiary hyperparathyroidism/end stage renal disease
21
Q

What investigations are indicated in primary hyperparathyroidism and what do they show?

A 
Serum calcium (raised)
Serum PTH (raised/normal)
Urine calcium (raised)
22
Q

How can malignancy cause hypercalcaemia?

A

Metastases
PTH related peptide (paraneoplastic)
Osteoclast activating factors

23
Q

How can hypercalcaemia from malignancy be investigated?

A

Calcium (raised)
Alkaline phosphate (raised)
Imaging (x-ray, CT, MRI)
Isotope bone scan

24
Q

How is acute hypercalcaemia treated?

A 
Fluids (0.9% saline 4-6L)
Loop diuretics once rehydrated
Biphosphonates 
Steroids (occasionally for inflammation)
Chemotherapy (malignant disease)
25
Q

Can thiazide diuretics be used in hypercalcaemia?

A

No

26
Q

What imaging scan can be used to detect parathyroid pathology?

A

Sestamibi scan

27
Q

How is primary hyperparathyroidism treated?

A

Surgery (not always required)

28
Q

Which parathyroid pathologies can cincalcet be used treat?

A

Tertiary hyperparathyroidism

Parathyroid carcinoma

29
Q

What are the indications for parathyroidectomy?

A

End organ damage (bone disease, gastric ulcer, renal stones, osteoporosis)
High calcium (>2.85)
Under 50
eGFR

30
Q

What is primary hyperparathyroidism? How does it present in terms of biochemistry?

A

Primary overactivity of parathyroid (e.g adenoma)

Calcium high & PTH high

31
Q

What is secondary hyperparathyroidism? How does it present in terms of biochemistry?

A

Physiological response to low calcium

Calcium low & PTH high

32
Q

What is tertiary hyperparathyroidism? How does it present in terms of biochemistry?

A

Parathyroid becomes automous after many years of secondary hyperparathyroidism
Calcium high & PTH high

33
Q

What genetic syndromes is parathyroid associated with?

A

Multiple endocrine neoplasia type 1 & 2

Familial hyperparathyroidism

34
Q

What is the biochemical picture with malignant hypercalcaemia?

A

Raised calcium
Normal phosphate
Raised alk phosphate

35
Q

What investigations are useful in suspected malignant hypercalcaemia?

A

X-ray

Bone scan

36
Q

How is myeloma screened for?

A

Protein electrophoresis
Benz jones
Skeletal survey

37
Q

Is familial hypocalciuric hypercalcaemia autosomal dominant or recessive?

A

Dominant

38
Q

How does familial hypocalciuric hypercalcaemia present?

A

Usually assymptomatic

39
Q

How is familial hypocalcuric hypercalcaemia investigated?

A

Mildly elevated blood calcium
Reduced urine calcium
PTH mildly elevated
Genetic screening

40
Q

What is the typical biochemistry of Paget’s?

A

Calcium, parathyroid hormone and phosphate normal

Alk phosphate raised

41
Q

What is the typical biochemistry of osteomalacia?

A

Calcium and phosphate low

Parathyroid hormone and alk phosphate raised

42
Q

What is the typical biochemistry of hypoparathyroidism?

A

Calcium and parathyroid hormone low

Alk phosphate and phosphate normal

43
Q

What is the typical biochemistry of malignant hypercalcaemia?

A

Calcium and alk phosphate raised
Parathyroid hormone low
Phosphate normal

44
Q

What is the typical biochemistry of primary hyperparathyroidism?

A

Calcium and parathyroid hormone raised
Alk phosphate normal
Phosphate low

Year 2 (72 decks)

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