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2 Endocrine > Calcium Disorders and Homeostasis > Flashcards

Calcium Disorders and Homeostasis Flashcards

1
Q

how is serum calcium increased in the body?

A

bone reabsorption
gut absorption
under the control of PTH!

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2
Q

what does calcium sensing receptor do?

A

senses Ca, if high:

decreases PTH release from parathyroid gland

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3
Q

does vitamin D up or downregulate PTH?

A

upregulates

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4
Q

acute presentation of hypercalcaemia?

A

thirst
dehydration
confusion
polyuria

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5
Q

chronic presentation of hypercalcaemia?

A 
"bones stones moans and groans" myopathy
osteopaenia
fractures
depression
hypertension
abdo pain
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6
Q

main test for hypercalcaemia?

A

PTH

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7
Q

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

A

dehydration

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8
Q 
what would you suspect fro:
high Ca
normal albumin
normal/high PTH
low/normal phosphate
increased urine Ca
A

primary hyperparathyroidism

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9
Q 
what would you suspect from:
high Ca
normal albumin
no PTH
high phosphate
A

bone pathology

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10
Q

what bone pathology would present with high ALP?

A

bone mets
sarcoidosis
thyrotoxicosis

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11
Q

what bone pathology would present with low ALP?

A

myeloma

vit d excess

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12
Q

drug causes of primary hypoparathyroidism?

A

vit d

thiazides

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13
Q

what kind of hypercalcaemia does granulomatous disease cause?

A

primary

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14
Q

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

A

raised
raised
raised

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15
Q

how should you treat someone with increased urine calcium?

A

ensure they’re vitamin d repleted

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16
Q

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

A

raised calcium

raised ALP

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17
Q

acute treatment for hypercalcaemia?

A

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

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18
Q

what diuretic should be used for hypercalcaemia?

A

loop only

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19
Q

when would you do a parathyroidectomy for primary hyperparathyroidism?

A

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

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20
Q

define primary hyperparathyroidism

A

primary overactivity of the prathyroid glands eg adenoma

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21
Q

effect of primary hyperparathyoidism on PTH and Ca?

A 
PTH = raised
Ca = raised
22
Q

effect of secondary hyperparathyroidism on PTH and Ca?

A 
PTH = raised
Ca = low
23
Q

define secondary hyperparathyroidism?

A

physiological response to low calcium

24
Q

define tertiary hyperparathyroidism?

A

parathyroid becomes autonomous after many years of secondary

25
Q

effect of tertiary hyperparathyroidism on PTH and Ca?

A 
Ca = raised
PTH = raised
26
Q

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

A

MEN1
MEN2
FHPT
familial hypocalciuric hypercalcaemia

27
Q

Ca reference range?

A

2.2-2.6mmol/l

28
Q

what would be found on tests of hypercalciuric hypocalcaemia?

A

mildly high Ca
reduced urine Ca excretion
PTH mildly elevated

29
Q

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

A

Ca normal/high
PTH normal
ALP high
phos normal

30
Q

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

A

Ca very low
PTH normal
ALP increased
phosphate low

31
Q

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

A

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

32
Q

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

A

Ca high
PTH normal/high
ALP normal
phosphate normal

33
Q

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

A

Ca very high
PTH very low
ALP vv high
phosphate normal

34
Q

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

A

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

35
Q

symptoms of hypocalcaemia?

A 
paraesthesia in fingers/toes/perioral
muscle cramps and weakness
fatigue
bronchospasm
fits
36
Q

common ECG finding of someone with hypocalcaemia?

A

prolonged QT

37
Q

causes of hypocalcaemia?

A

hypoparathyroidism
vitamin d deficiency
chronic renal failure
pancreatitis

38
Q

emergency treatment of someone with hypocalcaemia?

A

IV calcium gluconate

39
Q

what genetic syndrome is congenitally calcium deficient?

A

di george syndrome

40
Q

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

A

genetic cause

41
Q

how is hypocalcaemia managed?

A

> 1-2g per day

daily vitamin d tablets/injection every 6 months

42
Q

why do you get hypocalcaemia along with hypomagnasaemia sometimes?

A

calcium release from cells is dependent on Mg

PTH release is inhibited when Mg is low

43
Q

causes of hypomagnasaemia?

A 
alcohol 
drugs
Gi illness
pancreatitis
malabsorption
44
Q

what drugs can cause hypomagnasaemia?

A

thiazide

PPI

45
Q

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

A

low Ca

high PTH due to PTH resistance

46
Q

what drugs can cause vitamin d deficiency?

A

anticonvulsants

47
Q

what conditions represent vitamin d deficiency?

A

rickets

osteomalacia

48
Q

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

A

T, chronic renal failure can

49
Q

does osteomalacia present with high or low calcium?

A

low

50
Q

clinical presentation of osteomalacia?

A

dental problems
proximal myopathy
bony tenderness

51
Q

how would you treat vitamin D resistant rickets?

A

phosphate

vit d supplements

2 Endocrine (35 decks)

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