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SM Endocrine > Calcium Homeostasis and Disorders of Calcium Metabolism > Flashcards

Calcium Homeostasis and Disorders of Calcium Metabolism Flashcards

1
Q

What is involved in calcium homeostasis

A

Diet
Gut Absorption
PTH
Vitamin D

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2
Q

What are some acute symptoms of hypercalcaemia

A

Thirst
Dehydration
Confusion
Polyuria

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3
Q

What are some chronic symptoms of hypercalcaemia

A 
Myopathy
Osteopaenia
Fractures
Depression
Hypertension
Abdominal pain - pancreatitis, ulcers, renal stones
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4
Q

What is the most important test for hypercalcaemia

A

PTH

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5
Q

If the albumin is raised, what can happen to the urea

A

Can either be raised or normal

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6
Q

If the albumin is normal or low, what happens to PTH

A

suppressed

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7
Q

if the albumin is normal what happens to the PTH

A

It is normal or high

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8
Q

If the PTH is normal/ high, what happens to the urine calcium

A

Either increased or decreased

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9
Q

If the urine Ca is high, what does this indicate

A

Primary/ tertiary hyperparathyroidism

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10
Q

If the urine Ca is low, what does this indicate

A

FHH

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11
Q

What are the 3 reasons for having an elevated alkaline phosphatase

A

Bone mets
Sarcoidosis
Thyrotoxicosis

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12
Q

What are some reasons of having a suppressed alkaline phosphatase

A

Myeloma
Vitamin D deficiency
Mild alkali syndrome (thyrotoxicosis, sarcoidosis, raised HCO-3)

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13
Q

How can we make a diagnosis of primary hyperparathyroidism

A 
Raised serum calcium
Raised serum PTH 
Increased urine calcium excretion
Xray, CT, MRI
Isotope bone scan (malignancy)
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14
Q

What is the treatment for acute hypercalcaemia

A

IV saline 4-6L in 24 hours
Consider loop diuretics once rehydrated avoid thiazides
Bisphosphonates
Steroids occasionally
chemotherapy may reduce calcium in malignant disease

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15
Q

What is the gold standard treatment for hyperparathyroidism

A

Surgery

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16
Q

What are the indications for a parathyroidectomy

A

End organ damage
Very high calcium
under the age of 50
eGFR

17
Q

What are some of the end organ damages that can be seen in hyperparathyroidism

A

Bone disease (osteitis FIbosa et cystica)
Gastric ulcers
Renal stones
Osteoporosis

18
Q

What would be seen in blood results of someone with primary hyperparathyroidism

A

Ca raised

PTH raised

19
Q

What would be seen in blood results of someone with secondary hyperparathyroidism

A

Ca low

PTH raised

20
Q

What would be seen in blood results of someone with tertiary hyperparathyroidism

A

Ca raised

PTH raised

21
Q

What is primary hyperparathyroidism

A

Primary overactivity of parathyroid e.g. adenoma

22
Q

What is secondary hyperparathyroidism

A

Physiological response to low calcium

23
Q

What is tertiary hyperparathyroidism

A

Parathyroid becomes autonomous after many years of secondary hyperparathyroidism

24
Q

What are 3 genetic syndromes of Hyperparathyroidism

A

MEN1
MEN2
FHPT

25
Q

What are the causes of hypocaciuric Hypercalcaemia

A

Familial (aut Dom)

Usually benign / assymptomatic

26
Q

If a patient had Paget’s disease, what would happen to their biochemistry

A

Raised AP
Possibly raised Ca
Normal PTH and Phos

27
Q

If a patient had osteomalacia what would happen to their biochemistry

A

Increased PTH
Really increased AP
Decreased Phos
Really low Ca

28
Q

If a patient has hypoparathyroidism, what would happen to their biochemistry

A

Low Ca
Low PTH
normal AP
Normal or raised Phos

29
Q

If a patient has FHH, what would happen to their biochemistry

A

High Ca and PTH

Normal AP and Phos

30
Q

If a patient has malignancy, what would happen to their biochemistry

A

Raised Ca and AP
normal phos
low PTH

31
Q

If a patient has primary hypoparathyroidism, what would happen to their biochemistry

A

High Ca and PTH
Low Phos
Normal AP

SM Endocrine (27 decks)

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