Calcium Disorders Flashcards

1
Q

List clinical features of hypercalcaemia

A
Thirst, dehydration
Confusion
Polyuria
Myopathy
Osteopenia, fractures
Hypertension
Abdo pain (renal stones, pancreatitis)
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2
Q

List the main causes of hypercalcaemia

A
Hyperparathyroidism
Malignancy
Drugs (vit D, thiazides)
TB, sarcoidosis
High cell turnover (Paget's)
FHH
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3
Q

If you could do one test to investigate hypercalcaemia, what would you do?

A

Measure PTH levels

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4
Q

Outline management of hypercalcaemia

A

Fluid replacement
Loop diuretic
Biphosphonate

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5
Q

What is the difference between primary, secondary and tertiary hyperparathyroidism?

A

Primary: overactivity of PT gland due to adenoma
Secondary: physiological response to low Ca
Tertiary: PT becomes autonomous after years of secondary hyperparathyroidism

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6
Q

In primary hyperparathyroidism, PTH levels are high/low and calcium levels are high/low

A

PTH high

Calcium high

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7
Q

In secondary hyperparathyroidism, PTH levels are high/low and calcium levels are high/low

A

PTH high

Calcium low

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8
Q

What investigation is done for hyperparathyroidism?

A

Sestamibi scan - localises adenoma

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9
Q

What is FHH?

A

Familial hypercalciuric hypercalcaemia

Autosomal dominant disease where CaSR is mutated

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10
Q

List clinical features of hypocalcaemia

A
Paraesthesia
Muscle cramps/tetany/weakness
Fatigue
Bronchospasm
Chovstek sign
Trousseau sign
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11
Q

What is Chovstek sign in hypocalcaemia?

A

Tapping over facial nerve produces a twitch of muscle on the ipsilateral side

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12
Q

What is Trousseau sign in hypocalcaemia?

A

Carpopedal spasm when BP cuff is inflated + held for 3mins

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13
Q

What are the main causes of hypocalcaemia?

A

Hypoparathyroidism
Vitamin D deficiency
Chronic renal failure

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14
Q

List causes of hypoparathyroidism

A

Congenital (DiGeorge syndrome)
Trauma/iatrogenic
Autoimmunity
Low magnesium

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15
Q

What would levels of calcium, phosphate, PTH and ALP be like in hypoparathyroidism?

A

Calcium low
Phosphate high
PTH low
ALP normal

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16
Q

Which disease(s) are extreme manifestations of vitamin D deficiency?

A

Osteomalacia (adults)

Rickets (children)

17
Q

What would levels of calcium, phosphate, PTH and ALP be like in osteomalacia?

A

Calcium normal/low
Phosphate low
PTH normal
ALP high

18
Q

Outline treatment for (chronic) vitamin D deficiency

A

Vitamin D3 tablets
Calcitriol
Alfacalcidol

19
Q

What is pseudo-hypoparathyroidism?

A

Resistance to PTH, causing hypocalcaemia (even though PTH may very well be high)

20
Q

Which gene is defect in pseudo-hypoparathyroidism?

A

GNAS1 (causing dysfunction of G-protein)

21
Q

What (the fck) is pseudo-pseudo-hypoparathyroidism?

A

Phenotypically the individual has pseudo-hypoparathyroidism, but biochemical aspects are normal (i.e. normal calcium)

22
Q

Outline treatment of hypocalcaemia

A

IV calcium gluconate (acute)
Calcium supplements
Vitamin D supplements

23
Q

What are calcium, PTH, ALP and phosphate levels like in hyperparathyroidism?

A

Calcium high
PTH high
ALP normal/high
Phosphate normal

24
Q

What are calcium, PTH, ALP and phosphate levels like in bone malignancy?

A

Calcium high
PTH low
ALP high
Phosphate normal

25
Q

What are calcium, PTH, ALP and phosphate levels like in FHH?

A

Calcium high
PTH normal/high
ALP normal
Phosphate high

26
Q

What are calcium, PTH, ALP and phosphate levels like in hypoparathyroidism?

A

Calcium low
PTH low
ALP normal
Phosphate normal/high