Calcium Disorders Flashcards
list the clinical features of hypercalcaemia
thirst confusion polyuria myopathy osteopenia hypertension abdominal pain
list the main causes of hypercalcaemia
hyperparathyroidism malignancy drugs TB, sarcoidosis high cell turnover FHH
what is the best test to investigate hypercalcaemia?
measure PTH levels
outline management of hypercalcaemia
fluid replacement
loop diuretic
bisphosphonate
what is primary hyperparathyroidism?
overactivity of PT gland due to adenoma
what is secondary hyperparathyroidism?
physiological response to low calcium
what is tertiary hyperparathyroidism?
PT becomes autonomous after years of secondary hyperparathyroidism
describe the PTH and calcium levels in primary hyperparathyroidism
PTH high
calcium high
describe the PTH and calcium levels in secondary hyperparathyroidism
PTH high
calcium low
what investigation is done for hyperparathyroidism?
sestamibi scan - localises adenoma
what is FHH?
familial hypocalciuric hypercalcaemia
an autosomal dominant disease where CaSR is mutated
list clinical features of hypocalcaemia
paraesthesia muscle cramps/tetany/weakness fatigue bronchospasm chvostek sign trousseau sign
what is chvostek sign in hypocalcaemia?
tapping over the facial nerve produces a twitch of muscle on the ipsilateral side
what is trousseau sign in hypocalcaemia?
carpopedal spasm when BP cuff is inflated and held for three minutes
what are the three main causes of hypocalcaemia?
hypoparathyroidism
vitamin D deficiency
chronic renal failure
list causes of hypoparathyroidism
congenital (DiGeorge syndrome)
trauma
autoimmunity
low magnesium
what would levels of calcium, phosphate, PTH and ALP be like in hypoparathyroidism?
calcium - low
phosphate - high
PTH - low
ALP - normal
which diseases are extreme manifestations of vitamin D deficiency?
osteomalacia
ricket’s
what would levels of calcium, phosphate, PTH and ALP be like in osteomalacia?
calcium - normal/low
phosphate - low
PTH - normal
ALP - high
outline treatment for chronic vitamin D deficiency
vitamin D3 tablets
calcitriol
alfacalcidol
what is pseudo-hypoparathyroidism?
resistance to PTH, causing hypocalcemia
which gene has a defect in pseudo-hypoparathyroidism?
GNAS1
what is pseudo-pseudo-hypoparathyroidism?
phenotypically, the individual has pseudo-hypoparathyroidism but biochemical aspects are normal
outline treatment of hypocalcemia
IV calcium gluconate
calcium supplements
vitamin D supplements
what are calcium, PTH, ALP and phosphate levels like in hyperparathyroidism?
calcium - high
PTH - high
ALP - normal/high
phosphate - normal
what are calcium, PTH, ALP and phosphate levels like in bone malignancy?
calcium - high
PTH - low
ALP - high
phosphate - normal
what are calcium, PTH, ALP and phosphate levels like in FHH?
calcium - high
PTH - normal/high
ALP - normal
phosphate - high
what are calcium, PTH, ALP and phosphate levels like in hypoparathyroidism?
calcium - low
PTH - low
ALP - normal
phosphate - normal/high
