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Endocrinology > Calcium Balance Clinical > Flashcards

Calcium Balance Clinical Flashcards

1
Q

What are some dietary sources of calcium?

A

Milk
Cheese
Green leafy vegetables

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2
Q

What are the functions of calcium?

A

Bone formation
Cell division and growth
Muscle contraction
Neurotransmitter release

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3
Q

What % of calcium is bound to albumin?

A

40-45%

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4
Q

What is the normal range of calcium?

A

2.2-2.6 mmol/l

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5
Q

What effect does increased albumin have on free calcium?

A

Decreases it

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6
Q

What are good sources of vitamin D?

A

Sun
Oily fish
Eggs

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7
Q

Where do the parathroid glands lie?

A

On the posterior aspect of the neck

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8
Q

How many parathyroid glands are there usually?

A

4

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9
Q

What hormone does the parathyrod gland secrete?

A

PTH

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10
Q

What does PTH control?

A

Calcium levels

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11
Q

When is PTH secreted in response to?

A

To a fall in calcium

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12
Q

What is the direct effect of PTH?

A

Promots reabsorption of calcium from the renal tubules and bone

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13
Q

What does PTH mediate the conversion of?

A

Vitamin D from its inactive to its active form

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14
Q

What are the symptoms of acute hypocalcaemia?

A 
Paresthesia 
Muscle twitching 
Increase in muscle tone 
Seizures 
Laryngo and bronchospasm 
Prolonged QT interval Hypotension 
Papilloedema 
Trousseau's sign 
Chovstek's signs
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15
Q

Below what level will symptoms of hypocalcaemia usually present?

A

1.0 mmol/L

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16
Q

What is Chovstek’s Sign?

A

As the patients face is flicked the corner of the motuh spasms

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17
Q

What is Trosseau’s sign?

A

As BP is being checked the hand claws up

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18
Q

Why might someone with a recent thyroidectomy present with hypocalcaemia?

A

Due to the parathyroid glands being disturbed

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19
Q

Why might someone with a recewnt thyroidectomy present with hoarseness of voice?

A

As the reuccrent laryngeal nerve runs through the thyroid gland and can be damaged during surgery

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20
Q

What drug can typically cause Magensium deficiency?

A

Meprozol

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21
Q

What should be asked in a history with suspected hypocalcaemia?

A 
Ca and Vit D intake 
Neck surgery 
Autoimmune disorders
Medications
FH
22
Q

What might be seen on examination from neck surgery?

A

Neck scars

23
Q

What investigations should be done for hypocalcaemia?

A 
ECG 
Serum calcium 
Albumin 
Phosphate 
PTH 
U&E's
Vitamin D 
Magnesium
24
Q

What can cause hypoparathyroidism?

A 
Renal agnesis 
Destructin of the glands 
Infiltration 
Redcued secretion of PTH 
Resistance to PTH 
Vitamin D deficiency
25
Q

What causes pseudohypoparathyroidism?

A

Failure of target cells to respond to PTH

26
Q

What is characterisitc (clincial sign wise) of pseudohypoparathyroidism?

A

Short 4th and 5th finger

27
Q

What is PTH levels in pseudohypoparathyroidism?

A

They are elevated

28
Q

What is the treatment for mild hypocalcaemia?

A

Commence oral calcium tablets
If post thyroidectomy repeat after 24 hours
Stsrt vit D tablets if deficient
If Mg2+ low then remove precipitatin gdruug and replace Mg2+

29
Q

Rx for severe hypoglycaemia?

A

Medical emergency
IV calcium gluconate
Treat underlying cause

30
Q

What is treatment for vitamain D replacement?

A

dietary advice

Tablets combined with calcium

31
Q

When should vitamin D not be prescribed?

A

In severe renal impairment

32
Q

Why should vitamin D not be prescirbed in severe renal impairment?

A

Because vit D requires hydroxylation by the kidneys to its active form

33
Q

What is the key lood test for hypocalcaemia?

A

PTH

34
Q

What are the most common causes of hypercalcaemia?

A

Primary hyperparathyroidism

Hypercalcaemia of malignancy

35
Q

When PTH is low and there is hypercalcaemia is the cause primary or secondary?

A

Secondary

36
Q

What are the symptoms of hypercalcaemia?

A 
Polyruria 
Polydispia
Nephrolothiasis 
Anorexia 
Nausea and vomiting 
Constipation 
Muscle weakness Decreased concentration 
Shortening of the QT interval
37
Q

What are the investigations for hypercalcaemia?

A 
Ca
PO4
Albumin 
Myeloma screen 
Serum ACE 
PTH 
Alk phos
Consider an ECG
U&Es
38
Q

Does Primary Hyperparathyroidism mainly affect women or men?

A

Female

39
Q

What is primary hyperparathyroidism caused by?

A

Parathyroid adenoma
MEN type 1 or 2A
Parathyroid carcinoma

40
Q

What are the investigations for primary hyperparathyroidism?

A 
Ca 
PTH 
U&E’s
Abdominal imaging 
DEXA 
Exc FHH 
Vitamin D 
Parathyroid USS
41
Q

What are the indications for surgery in primary hyperparathyroidism?

A 
Presence of symptoms 
Serum calcium >0.25 mmol/L above upper range limit 
Osteoporosis 
eGRF<60 or presence of kidney stones 
<50 years
42
Q

What is the medical management of primary hyperparathyroidism?

A

Generous fliud intake

Cincacalet

43
Q

What is the action of cinaclcet?

A

Mimics the effect of calcium on the calcium sensing receptors on chief cells
Leading to a fall in PTH
and consequently a fall in calcium levels

44
Q

What is FHH?

A

Autosomal dominant disorder of the calcium sensing receptor

45
Q

What is MEN type 1?

A

MEN 1 is characterised by the combination of parathyroid tumours, pancreatic islet cell tumours, and anterior pituitary tumours

46
Q

When does MEN type1 usually present?

A

2nd to 4th decade of life

47
Q

What is the most common presentation of MEN type 1?

A

Primary hyperparathyroidism

48
Q

What is the management for hyperparathyroidism?

A

Rehydration
Consider dialysis if severe kidney failure
IV biphosphonates

49
Q

What is MEN type 2A?

A

Multiple endocrine neoplasia type 2 (MEN2) is a hereditary condition associated with three primary types of tumors: medullary thyroid cancer, parathyroid tumors, and pheochromocytoma.

50
Q

Where is the mutation in MEN type 1?

A

MENIN

51
Q

Where is the mutation in MEN type 2A?

A

RET

Endocrinology (19 decks)

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