Calcium Homeostasis and Disorders of Calcium Metabolism Flashcards
What is involved in calcium homeostasis
Diet
Gut Absorption
PTH
Vitamin D
What are some acute symptoms of hypercalcaemia
Thirst
Dehydration
Confusion
Polyuria
What are some chronic symptoms of hypercalcaemia
Myopathy Osteopaenia Fractures Depression Hypertension Abdominal pain - pancreatitis, ulcers, renal stones
What is the most important test for hypercalcaemia
PTH
If the albumin is raised, what can happen to the urea
Can either be raised or normal
If the albumin is normal or low, what happens to PTH
suppressed
if the albumin is normal what happens to the PTH
It is normal or high
If the PTH is normal/ high, what happens to the urine calcium
Either increased or decreased
If the urine Ca is high, what does this indicate
Primary/ tertiary hyperparathyroidism
If the urine Ca is low, what does this indicate
FHH
What are the 3 reasons for having an elevated alkaline phosphatase
Bone mets
Sarcoidosis
Thyrotoxicosis
What are some reasons of having a suppressed alkaline phosphatase
Myeloma
Vitamin D deficiency
Mild alkali syndrome (thyrotoxicosis, sarcoidosis, raised HCO-3)
How can we make a diagnosis of primary hyperparathyroidism
Raised serum calcium Raised serum PTH Increased urine calcium excretion Xray, CT, MRI Isotope bone scan (malignancy)
What is the treatment for acute hypercalcaemia
IV saline 4-6L in 24 hours
Consider loop diuretics once rehydrated avoid thiazides
Bisphosphonates
Steroids occasionally
chemotherapy may reduce calcium in malignant disease
What is the gold standard treatment for hyperparathyroidism
Surgery
What are the indications for a parathyroidectomy
End organ damage
Very high calcium
under the age of 50
eGFR
What are some of the end organ damages that can be seen in hyperparathyroidism
Bone disease (osteitis FIbosa et cystica)
Gastric ulcers
Renal stones
Osteoporosis
What would be seen in blood results of someone with primary hyperparathyroidism
Ca raised
PTH raised
What would be seen in blood results of someone with secondary hyperparathyroidism
Ca low
PTH raised
What would be seen in blood results of someone with tertiary hyperparathyroidism
Ca raised
PTH raised
What is primary hyperparathyroidism
Primary overactivity of parathyroid e.g. adenoma
What is secondary hyperparathyroidism
Physiological response to low calcium
What is tertiary hyperparathyroidism
Parathyroid becomes autonomous after many years of secondary hyperparathyroidism
What are 3 genetic syndromes of Hyperparathyroidism
MEN1
MEN2
FHPT
What are the causes of hypocaciuric Hypercalcaemia
Familial (aut Dom)
Usually benign / assymptomatic
If a patient had Paget’s disease, what would happen to their biochemistry
Raised AP
Possibly raised Ca
Normal PTH and Phos
If a patient had osteomalacia what would happen to their biochemistry
Increased PTH
Really increased AP
Decreased Phos
Really low Ca
If a patient has hypoparathyroidism, what would happen to their biochemistry
Low Ca
Low PTH
normal AP
Normal or raised Phos
If a patient has FHH, what would happen to their biochemistry
High Ca and PTH
Normal AP and Phos
If a patient has malignancy, what would happen to their biochemistry
Raised Ca and AP
normal phos
low PTH
If a patient has primary hypoparathyroidism, what would happen to their biochemistry
High Ca and PTH
Low Phos
Normal AP
