Calcium Disorders and Homeostasis

Question 1

how is serum calcium increased in the body?

Answer 1

bone reabsorption
gut absorption
under the control of PTH!

Question 2

what does calcium sensing receptor do?

Answer 2

senses Ca, if high:

decreases PTH release from parathyroid gland

Question 3

does vitamin D up or downregulate PTH?

Answer 3

upregulates

Question 4

acute presentation of hypercalcaemia?

Answer 4

thirst
dehydration
confusion
polyuria

Question 5

chronic presentation of hypercalcaemia?

Answer 5

"bones stones moans and groans" myopathy
osteopaenia
fractures
depression
hypertension
abdo pain

Question 6

main test for hypercalcaemia?

Answer 6

PTH

Question 7

what would you suspect from:
high urea
high albumin
high Ca

Answer 7

dehydration

Question 8

what would you suspect fro:
high Ca
normal albumin
normal/high PTH
low/normal phosphate
increased urine Ca

Answer 8

primary hyperparathyroidism

Question 9

what would you suspect from:
high Ca
normal albumin
no PTH
high phosphate

Answer 9

bone pathology

Question 10

what bone pathology would present with high ALP?

Answer 10

bone mets
sarcoidosis
thyrotoxicosis

Question 11

what bone pathology would present with low ALP?

Answer 11

myeloma

vit d excess

Question 12

drug causes of primary hypoparathyroidism?

Answer 12

vit d

thiazides

Question 13

what kind of hypercalcaemia does granulomatous disease cause?

Answer 13

primary

Question 14

biochemical results for primary hyperparathyroidism:
serum Ca
serum PTH
urine calcium

Answer 14

raised
raised
raised

Question 15

how should you treat someone with increased urine calcium?

Answer 15

ensure they’re vitamin d repleted

Question 16

what biochemical results would indicate hypercalcaemia as a result of malignancy?

Answer 16

raised calcium

raised ALP

Question 17

acute treatment for hypercalcaemia?

Answer 17

rehydrate with 0.9% saline 4-6l in 24hrs

Question 18

what diuretic should be used for hypercalcaemia?

Answer 18

loop only

Question 19

when would you do a parathyroidectomy for primary hyperparathyroidism?

Answer 19

end organ damage eg osteoporosis, renal stones
calcium >2.85mmol/l
age <50

Question 20

define primary hyperparathyroidism

Answer 20

primary overactivity of the prathyroid glands eg adenoma

Question 21

effect of primary hyperparathyoidism on PTH and Ca?

Answer 21

PTH = raised
Ca = raised

Question 22

effect of secondary hyperparathyroidism on PTH and Ca?

Answer 22

PTH = raised
Ca = low

Question 23

define secondary hyperparathyroidism?

Answer 23

physiological response to low calcium

Question 24

define tertiary hyperparathyroidism?

Answer 24

parathyroid becomes autonomous after many years of secondary

Question 25

effect of tertiary hyperparathyroidism on PTH and Ca?

Answer 25

``` Ca = raised PTH = raised ```

Question 26

what genetic syndromes can be responsible for high calcium in the body?

Answer 26

MEN1 MEN2 FHPT familial hypocalciuric hypercalcaemia

Question 27

Ca reference range?

Answer 27

2.2-2.6mmol/l

Question 28

what would be found on tests of hypercalciuric hypocalcaemia?

Answer 28

mildly high Ca reduced urine Ca excretion PTH mildly elevated

Question 29

what would Ca, PTH, ALP and phosphate look like in someone with pagets?

Answer 29

Ca normal/high PTH normal ALP high phos normal

Question 30

what would, Ca, PTH, ALP and phosphate look like in someone with osteomalacia?

Answer 30

Ca very low PTH normal ALP increased phosphate low

Question 31

what would Ca, PTH, ALP, phosphate look like in someone with hypoparathyroidism?

Answer 31

Ca very low PTH very low ALP normal phosphate normal/high

Question 32

what would Ca, PTH, ALP and phosphate in familial hypocalciuric hypercalcaemia look like?

Answer 32

Ca high PTH normal/high ALP normal phosphate normal

Question 33

what would Ca, PTH, ALP and phosphate in malignant hypercalcaemia look like?

Answer 33

Ca very high PTH very low ALP vv high phosphate normal

Question 34

what would Ca, PTH, ALP and phosphate in primary hyperparathyroidism look like?

Answer 34

Ca v high PTH v high ALP normal/high phosphate decreased

Question 35

symptoms of hypocalcaemia?

Answer 35

``` paraesthesia in fingers/toes/perioral muscle cramps and weakness fatigue bronchospasm fits ```

Question 36

common ECG finding of someone with hypocalcaemia?

Answer 36

prolonged QT

Question 37

causes of hypocalcaemia?

Answer 37

hypoparathyroidism vitamin d deficiency chronic renal failure pancreatitis

Question 38

emergency treatment of someone with hypocalcaemia?

Answer 38

IV calcium gluconate

Question 39

what genetic syndrome is congenitally calcium deficient?

Answer 39

di george syndrome

Question 40

what would you suspect in a young person with primary hyperparathyroidism?

Answer 40

genetic cause

Question 41

how is hypocalcaemia managed?

Answer 41

>1-2g per day | daily vitamin d tablets/injection every 6 months

Question 42

why do you get hypocalcaemia along with hypomagnasaemia sometimes?

Answer 42

calcium release from cells is dependent on Mg | PTH release is inhibited when Mg is low

Question 43

causes of hypomagnasaemia?

Answer 43

``` alcohol drugs Gi illness pancreatitis malabsorption ```

Question 44

what drugs can cause hypomagnasaemia?

Answer 44

thiazide | PPI

Question 45

what Ca and PTH levels indicate pseudohypoparathyridism? why are they like this?

Answer 45

low Ca | high PTH due to PTH resistance

Question 46

what drugs can cause vitamin d deficiency?

Answer 46

anticonvulsants

Question 47

what conditions represent vitamin d deficiency?

Answer 47

rickets | osteomalacia

Question 48

kidney problems can cause vitamin d deficiency: T or F?

Answer 48

T, chronic renal failure can

Question 49

does osteomalacia present with high or low calcium?

Answer 49

low

Question 50

clinical presentation of osteomalacia?

Answer 50

dental problems proximal myopathy bony tenderness

Question 51

how would you treat vitamin D resistant rickets?

Answer 51

phosphate | vit d supplements