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Erin Y2 - Endocrine > Bones, Calcium and Parathyroid Gland > Flashcards

Bones, Calcium and Parathyroid Gland Flashcards

1
Q

What are the 2 main causes of hypercalcaemia?

A

Primary hyperparathyroidism

Malignancy

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2
Q

What are other causes of hypercalcaemia?

A 
Tertiary hyperparathyroidism
Drugs (excess vit D, thiazides)
Granulomatous diseases (sarcoidosis, TB)
Familial hypercalciuric hypercalcaemia
High calcium turnover (bedridden, thyrotoxicosis, Paget's)
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3
Q

What biochemistry test results would be found in primary hyperparathyroidism?

A

↑PTH (or inappropriately normal)
↑Ca2+
↑urine calcium excretion
Vit D should be replete

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4
Q

What biochemistry test results would be found in hypercalcaemia caused by malignancy?

A

↑Ca2+
↑ALP
↓PTH

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5
Q

What are the signs + symptoms of hypercalcaemia?

A

Bones (bone pain, fractures, bony lesions)
Stones (kidney stones)
GI moans (constipation, peptic ulcers)
Psychic moans (depression, hallucination, confusion, stupor, memory loss)
Muscle weakness, slow or absent relfexes

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6
Q

What are the signs + symptoms of acute hypercalcaemia?

A

Thirst
Dehydration
Confusion
Polyuria

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7
Q

What are the signs + symptoms of chronic hypercalcaemia?

A 
Myopathy
Fractures
Osteopenia
Depression
Hypertension
Pancreatitis
Ulcers
Renal calculi
Calcium-induced nephrogenic diabetes insipidus
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8
Q

How can hypercalcaemia be investigated?

A

Measure calcium, PTH, vit D, ALP
Urine - hypercalciuria
Imaging
ECG

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9
Q

What is the acute treatment for hypercalcaemia?

A
  1. Fluids
  2. Loop diuretics
  3. Glucocorticoids
  4. Bisphosphates
  5. Chemotherapy
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10
Q

What causes hypocalcaemia?

A 
Hypoparathyroidism
Osteomalacia
CKD
Vit D deficiency
Acute pancreatitis
Over-hydration
Respiratory alkalosis
Acute rhabdomyolysis
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11
Q

What are the signs + symptoms of hypocalcaemia?(SPAMODIC)

A 
Spasms
Paraesthesia
Anxious
Seizures
Muscles (cramps, weakness, ↑tone, tetany)
Orientation impaired and confusion
Dermatitis
Impetigo herptiformis
Chvostek's signs
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12
Q

What complications can hypocalcaemia cause?

A

QT segment prolongation (can lead to cardiac arrest)

Cataract formation

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13
Q

What is the treatment for acute hypocalcaemia?

A

Calcium gluconate (10mls of 10% over 10mins IV)

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14
Q

What is the pathogenesis of primary hyperparathyroidism?

A

Primary overactivity of the parathyroid gland

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15
Q

What is the most common cause of primary hyperparathyroidism?

A

Small parathyroid adenomas

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16
Q

What are the other causes of primary hyperparathyroidism?

A

Parathyroid hyperplasia
MEN1 (parathyroid hyperplasia, adenoma)
MEN2 (parathyroid hyperplasia)

17
Q

What is the treatment/management of primary hyperparathyroidism?

A

Parathyroidectomy

Cinacalcet (if unfit for surgery and needs treatment)

18
Q

What is cincalcet?

A

Calcium mimetic, reduces PTH secretion

19
Q

What is the pathogenesis for secondary hyperparathyroidism?

A

Chronic hypocalcaemia causes compensatory over activity of the parathyroid glands

20
Q

What are the causes of secondary hyperparathyroidism?

A

Vitamin D deficiency

CKD

21
Q

What biochemistry test results would be seen in secondary hyperparathyroidism?

A

↓ (or normal) Ca2+

↑PTH

22
Q

What is the treatment/management of secondary hyperparathyroidism?

A

Treatment of underlying cause (vitamin D, cinacalcet)

23
Q

What is the pathogenesis of tertiary hyperparathyroidism?

A

Parathyroid hyperplasia
When secondary hyperparathyroidism is treated but the parathyroid gland is used to producing lots of PTH so continues to do so

24
Q

What biochemistry test results would be seen in tertiary hyperparathyroidism?

A

↑Ca2+ (hypercalcaemia occurs as PTH is secreted unlimitedly by feedback control)
↑↑PTH

25
Q

What is the treatment/management of tertiary hyperparathyroidism?

A

Removal of some of the hyperplasia

26
Q

What is the pathogenesis of malignant hyperparathyroidism?

A

Parathyroid-related protein (PTHrP) is produced by some squamous cell lung cancer, breast and renal cell carcinoma causing an increase in Ca2+

27
Q

What biochemistry test results would be seen in malignant hyperparathyroidism?

A

↑Ca2+

↓PTH

28
Q

What scan can be done to localise parathyroid adenoma?

A

Sestamibi scan

29
Q

What are the complications of hyperparathyroidism?

A

Bone disease
Kidney stones
GI groans (constipation, nausea, peptic ulcer, pancreatitis, gall stones)
Depression, lethargy, seizures
Muscular weakness and fatigue
Calcification of aortic and mitral valves

30
Q

What are the primary causes of hypoparathyroidism?

A

Autoimmune
Idiopathic
Congenital deficiency (DiGeorge syndrome)
Familial

31
Q

What are the secondary causes of hypoparathyroidism?

A

Destruction of the parathyroid gland (removal or damage during thyroidectomy, radiotherapy, malignancy)
Hypomagnesaemia

32
Q

What are the causes of hypomagnesaemia?

A 
Alcohol
Drugs (thiazide diuretics, PPIs)
GI illness
Pancreatitis
Malabsorption
33
Q

What is the pathogenesis for pseudohypoparathyroidism?

A

Genetic defect causes failure of target cells to respond to PTH as the PTH receptors doesn’t work

34
Q

What are the signs + symptoms of pseudohypoparathyroidism?

A 
Bone abnormalities
Obesity
Subcutaneous calcification
Learning disabilities
Brachydactyly (short 4th and 5th metacarpals)
Calcified basal ganglia in brain
Short stature
35
Q

What is pseudopseudohypoparathyroidism?

A

Morphological features of pseudohypoparathyroidism but with normal biochemistry

36
Q

What biochesmistry results are seen in pseudohypoparathyroidism?

A

↓Ca2+

↑PTH (due to PTH resistance), ↑phosphate

37
Q

What biochesmistry results are seen in hypoparathyroidism?

A

↓Ca2+
↓PTH
↑phosphate

38
Q

What are the complications of hypoparathyroidism?

A

Prolonged QT interval in ECG (arrhythmias)
Dental abnormalities
Cataracts

39
Q

What is the treatment/management for hypoparathyroidism?

A 
Vitamin D (alphacalcidol, cholecalciferol, calcitriol)
Calcium

Erin Y2 - Endocrine (5 decks)

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