calcium

Question 1

What is the most common cause of hypercalcaemia in the UK in hospitalised patients?

Answer 1

Metastatic cancer accounts for most cases of hypercalcaemia in hospitalised patients.

Question 2

What is the most common cause of hypercalcaemia in the UK in non- hospitalised patients?

Answer 2

In the community primary hyperparathyroidism is the commonest cause.

Question 3

2 most common causes of hypercalcamia

Answer 3

Two conditions account for 90% of cases of hypercalcaemia:

1. Primary hyperparathyroidism: commonest cause in non-hospitalised patients
2. Malignancy: the commonest cause in hospitalised patients. This may be due to number of processes, including; bone metastases, myeloma, PTHrP from squamous cell lung cancer

Other causes include
sarcoidosis*
vitamin D intoxication
acromegaly
thyrotoxicosis
Milk-alkali syndrome
drugs: thiazides, calcium containing antacids
dehydration
Addison's disease
Paget's disease of the bone**

Question 4

Mnemonic for the causes of hypercalcaemia:

Answer 4

CHIMPANZEES

C alcium supplementation
H yperparathyroidism
I atrogentic (Drugs: Thiazides)
M ilk Alkali syndrome
P aget disease of the bone
A cromegaly and Addison's Disease
N eoplasia 
Z olinger-Ellison Syndrome (MEN Type I)
E xcessive Vitamin D
E xcessive Vitamin A
S arcoidosis

Question 5

Mnemonic for the causes of hypercalcaemia:

Answer 5

CHIMPANZEES

C alcium supplementation
H yperparathyroidism
I atrogentic (Drugs: Thiazides)
M ilk Alkali syndrome
P aget disease of the bone
A cromegaly and Addison's Disease
N eoplasia 
Z olinger-Ellison Syndrome (MEN Type I)
E xcessive Vitamin D
E xcessive Vitamin A
S arcoidosis

Question 6

Mnemonic for the causes of hypercalcaemia:

Answer 6

CHIMPANZEES

C alcium supplementation
H yperparathyroidism
I atrogentic (Drugs: Thiazides)
M ilk Alkali syndrome
P aget disease of the bone
A cromegaly and Addison's Disease
N eoplasia 
Z olinger-Ellison Syndrome (MEN Type I)
E xcessive Vitamin D
E xcessive Vitamin A
S arcoidosis

Question 7

what the ion is required for PTH secretion and its action on target tissue that can cause hypocalcaemia and render patients unresponsive to treatment with calcium and vitamin D supplementation.

Answer 7

magnesium

Question 8

A 43-year-old Caucasian male presents to his physician with numbness in his peripheries and pins and needles around the mouth and lips. He has a past surgical history of thyroidectomy. A full cranial nerve examination is performed and the only notable finding is twitching of the facial muscles on tapping over the patient’s face.

Which of the following explains the sign exhibited on tapping the patient’s face?

Answer 8

increased irritability of the nerve die to hypocalcaeima Chvostek’s sign is seen in hypocalcaemia due to increased irritability of the peripheral nerves