Calcium Dysregulation - Clinical Case Flashcards
A 55 year old South Asian gentleman presented to his GP with aches and pains. On examination he had evidence of proximal myopathy.
His GP performed some blood tests:
Normal renal function
Serum calcium: 2.10 (2.15 – 2.60 mmol/L)
Serum phosphate: 0.8 (0.80 – 1.40 mmol/L)
25 hydroxyvitamin D: 10 (70 – 150 nmol/L)
PTH: 20 (1.1 – 6.8 pmol/L)
What is the diagnosis?
Secondary hyperparathyroidism due to low vitamin D (osteomalacia)
* Serum calcium (low)
* Serum phosphate (in low range)
* 25 hydroxyvitamin D (low)
* PTH (high)
A 55 year old South Asian gentleman presented to his GP with aches and pains. On examination he had evidence of proximal myopathy.
His GP performed some blood tests:
Normal renal function
Serum calcium: 2.10 (2.15 – 2.60 mmol/L)
Serum phosphate: 0.8 (0.80 – 1.40 mmol/L)
25 hydroxyvitamin D: 10 (70 – 150 nmol/L)
PTH: 20 (1.1 – 6.8 pmol/L)
What risk factors does he have for developing this?
- Diet (low vit. D intake if vegeterian)
- South asian (high pigmentation -> low UV absorption -> low vit D)
- Low UV in UK
A 55 year old South Asian gentleman presented to his GP with aches and pains. On examination he had evidence of proximal myopathy.
His GP performed some blood tests:
Normal renal function
Serum calcium: 2.10 (2.15 – 2.60 mmol/L)
Serum phosphate: 0.8 (0.80 – 1.40 mmol/L)
25 hydroxyvitamin D: 10 (70 – 150 nmol/L)
PTH: 20 (1.1 – 6.8 pmol/L)
What treatment should be offered?
Vitamin D suppliments (25-hydroxy vitamin D)
A 55 year old South Asian gentleman presented to his GP with loin pain, which was worse on passing urine. His GP detected microscopic haematuria on a urine dipstick.
His GP checked some blood tests:
Normal renal function
Serum calcium: 2.90 (2.15 – 2.60 mmol/L )
Serum phosphate: 0.6 (0.80 – 1.40 mmol/L)
25 hydroxyvitamin D: 84 (70 – 150 nmol/L)
PTH: 12 (1.1 – 6.8 pmol/L)
What is the diagnosis?
Primary hyperparathyroidism
* Hypercalcaemia
* Hyperparathyroidism
* 55yo South Asian
* Loin pain
* Microscopi haematuria
* Low phosphate
* Normal Vit. D
A 55 year old South Asian gentleman presented to his GP with loin pain, which was worse on passing urine. His GP detected microscopic haematuria on a urine dipstick.
His GP checked some blood tests:
Normal renal function
Serum calcium: 2.90 (2.15 – 2.60 mmol/L )
Serum phosphate: 0.6 (0.80 – 1.40 mmol/L)
25 hydroxyvitamin D: 84 (70 – 150 nmol/L)
PTH: 12 (1.1 – 6.8 pmol/L)
What is the cause of his loin pain?
- Hypercalcaemia result in calclium kidney stones. Pain is the stone going through the ureter
A 55 year old South Asian gentleman presented to his GP with loin pain, which was worse on passing urine. His GP detected microscopic haematuria on a urine dipstick.
His GP checked some blood tests:
Normal renal function
Serum calcium: 2.90 (2.15 – 2.60 mmol/L )
Serum phosphate: 0.6 (0.80 – 1.40 mmol/L)
25 hydroxyvitamin D: 84 (70 – 150 nmol/L)
PTH: 12 (1.1 – 6.8 pmol/L)
How should he be treated?
- Parathyroidectomy (Remove the parathyroidoadenoma)
- Lithiotripsy to remove stones
- Drink a lot of water to pass the stone
A 51-year-old woman attends her GP’s surgery. She is tired, with aches and pains all over her body for several months. She feels low in mood. She has noticed that she has become more constipated previously.
She had a left mastectomy and adjuvant radiotherapy for breast cancer 3 years ago.
Her GP checks some blood tests:
Normal renal function
Serum calcium: 3.00 (2.15 – 2.60 mmol/L )
Serum phosphate: 1.00 (0.80 – 1.40 mmol/L)
25 hydroxyvitamin D: 70 (70 – 150 nmol/L)
PTH: < 1.1 (1.1 – 6.8 pmol/L)
What is the diagnosis?
- Hypercalcaemia due to malignancy
A 51-year-old woman attends her GP’s surgery. She is tired, with aches and pains all over her body for several months. She feels low in mood. She has noticed that she has become more constipated previously.
She had a left mastectomy and adjuvant radiotherapy for breast cancer 3 years ago.
Her GP checks some blood tests:
Normal renal function
Serum calcium: 3.00 (2.15 – 2.60 mmol/L )
Serum phosphate: 1.00 (0.80 – 1.40 mmol/L)
25 hydroxyvitamin D: 70 (70 – 150 nmol/L)
PTH: < 1.1 (1.1 – 6.8 pmol/L)
How should she be treated?
- Bisphosphonates or Denosumab to reduce osteoclast’s activity (medication used for osteoporosis)
