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Endocrine > Calcium Disorders > Flashcards

Calcium Disorders Flashcards

1
Q

What are the common causes of hypercalcaemia?

A

90% are either:

  • Primary Hyperparathyroidism
  • Malignant Hypercalcaemia

OTher:

  • Familial Hypocalciuric Hypercalcaemia (FHH)
  • Drugs e.g. Thiazide diuretic or Lithium
  • Sarcoid
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2
Q

What causes Primary Hyperparathyroidism?

A

85% are adenomas
~15% are 4 gland hyperplasia

Very rarely:

  • MEN 1 or 2A
  • Parathyroid Carcinoma
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3
Q

How does Hypercalcaemia present?

A

GI - Anorexia, Constipation & N&V

CV - Short QT, Hypertension & Bradycardia

Neuro - Loss of Conc. & confusion

Renal - Polyuria & Polydipsia + Nephrolithiasis

MSK - Muscle Weakness & bone pain

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4
Q

How does Primary Hyperparathyroidism present?

A

Its generally asymptomatic but can cause symptoms of hypercalcaemia

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5
Q

What is Familial Hypocalciuric Hypercalcaemia?

A

An autosomal dominant disorder causing Calcium-Sensing Receptor (CaSR) defects

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6
Q

What tests are appropriate for Hypercalcaemia?

hint theres loads

A
  • Serum Ca, PO4, PTH & Albumin
  • Serum ACE (Sarcoid)
  • 24 hour urine collection for calcium (low = FHH)
  • U&Es
  • ALKP
  • Lymph node exam (malignancy)
  • Myeloma screen (osteolytic metastases)
  • ECG (short QT)
  • FH
  • Med History

Abdo US for kidney stones
Parathyroid US for adedomas etc.

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7
Q

What are the initial tests for hypercalcaemia?

A

Serum Ca / PO4 / PTH / Albumin

FH & Med history

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8
Q

What are the “levels” of hypercalcaemia?

A

<3mmol/l - Generally aymptomatic

3-3.5mmol/l -~symptomatic & prompt treatment needed

> 3.5mmol/l - Emergency. Risks Dysrhythmia & coma

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9
Q

How do you treat hypercalcaemia first?

A

Rehydration & IV bisphosphonates (inhibit osteoclasts)

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10
Q

What can you give hypercalcaemics when bisphosphonates fail/arn’t tolerated?

A

Calcitonin

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11
Q

What treatments are there for lymphma or granulomatous disease causing hypercalcaemia?

A

Glucocorticoids e.g. Hydrocortisone

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12
Q

How would we treat Primary Hyperparathyroidism Hypercalcaemia?

A

Parathyroidectomy

OR

Calcimetics e.g. Cinacalcet

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13
Q

Summary of Hypercalcaemia treatments?

A

1st) Rehydrate and IV bisphosphonates

  • Calcitonin
  • Cinacalcet
  • Parathyroidectomy
  • Glucocorticoids
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14
Q

How does PTH differentiate the cause of Hypercalcaemia?

A

In hypercalcaemia PTH should be low.
If it is then the cause is outside the Parathyroid e.g. malignancy or drugs

If its high then theres some reason PTH is overproduced e.g. FHH, renal failure or Primary hyperparathyroidism

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15
Q

What are the main causes of Hypocalcaemia?

A

Low PTH aka hypoparathyroidism:

  • Neck surgery e.g. thyroidectomy
  • Autoimmune
  • Magnesium Deficiency
  • CaSR defect

High PTH (2nd* Hyperparathyroidism due to hypocalcaemia):

  • Renal Disease
  • Pseudohypoparathyroidism
  • Pancreatitis
  • Vit D deficiency

Inhibition of Bone resorption e.g. Bisphosphonates

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16
Q

What is Pseudohypoparathyroidism?

A

A set of disorders in which target organs like kidneys & bone become unresponsive to PTH

17
Q

What causes pseudohypoparathyroidism?

A
  • Agenesis e.g. Digeorge syndrome
  • Destruction e.g. surgery
  • Infiltration e.g. haemachromatosis or Wilson’s
  • Hypomagnesaemia
  • PTH resistance

low calcium, high phosphate, high PTH

18
Q

What special about pseudohypoparathyroidism presentation?

A

Albright’s Hereditary Osteodystrophy (AHO):

  • Obesity
  • Short Stature
  • Short Metacarpals

Low Ca
High PO4 & PTH (hence pseudo)

19
Q

At what Serum Ca2+ level do symptoms of hypocalcaemia appear?

A

Around 1.9mmol/l

20
Q

How does hypocalcaemia present?

A

Lots of symptoms, main ones are:

  • Paraesthesia
  • Muscle twitchin
  • Trosseaus sign
  • Chovstek’s Sign

Prolonged QT
Hypotension
Papilloedema

21
Q

What are the named signs of hypocalcaemia?

A

Trosseau’s sign = Attach a tight BP cuff and watch the patients hand slowly form a claw

Chovstek’s Sign = Facial twitch when you tap on the parotid over the Facial nerve

22
Q

What tests are appropriate for Hypocalcaemia?

A

Serum Ca, albumin, PO4

PTH (High Pseudoparathyroidism vs low Hypoparathyroidism)

Mg (Mg deficiency)

U&Es (renal failure)

Vit D (Vit D deficiency)

ECG

23
Q

Explain how blood tests will appear for the 2 biggest causes of hypocalcaemia?

A

Vit D deficiency - Low Ca, low PO4 & high PTH

Hypoparathyroidism - Low Ca, High PO4 & low PTH

Also pseudoparathyroidism
- Low Ca, High PO4 and high PTH

24
Q

How do you treat mild Hypocalcaemia?

A

Mild meaning >1.9mmol/l and asymptomatic.

Put them on oral Ca2+ suppleents

Also Oral Vit D tablets and Mg replacement as appropriate

25
Q

How do you treat severe hypocalcaemia?

A

Severe meaning symptoms or <1.9mmol/l
Considered a medical emergency

IV Calcium Gluconate

Then treat cause

26
Q

why do you test albumin?

A

Some calcium is albumin bound, to find a true serum calcium do serum calcium and serum albumin.
Then add 0.1mmol/l for every 5g/l reduction in Albumin from 40g/l

Endocrine (25 decks)

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