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Endocrinology > Calcium-related clinical conditions > Flashcards

Calcium-related clinical conditions Flashcards

1
Q

What is the function of calcium in the blood?

A

It is clotting factor 4

involved in the clotting cascade

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2
Q

What does a calcium chelator do?

A

Binds calcium

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3
Q

What are some examples of calcium chelators?

A

EDTA

Citrate

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4
Q

How is EDTA used clinically? Why?

A

Put into blood tubes

to prevent blood from clotting

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5
Q

How is citrate used clinically? Why?

A

Put into blood bags

to prevent blood from clotting

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6
Q

Patients who are given large blood transfusions must also be given what? Why?

A

IV calcium

to compensate for the calcium chelated by citrate
so patients blood can clot

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7
Q

In blood test results, which serum calcium value is looked at?

A

The adjusted/corrected one

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8
Q

What is the most common cause of hypercalcaemia?

A

Malignancies that have metastasised to bone

and are osteolytic

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9
Q

What are some cancers that commonly metastasise to bone? Which ones are osteolytic?

A

Breast cancer - osteolytic

Lung cancer - osteolytic

Renal cancer - osteolytic

Thyroid cancer - osteolytic

Prostate cancer

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10
Q

How does prostate cancer affect bone?

A

It is osteoblastic

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11
Q

Which bones are most commonly invaded by metastases?

A

Skull

Ribs

Vertebrae

Pelvis

Proximal femur

Proximal humerus

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12
Q

What are the types of hyperparathyroidism?

A

Primary

Secondary

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13
Q

What causes primary hyperparathyroidism?

A

One of four parathyroid glands develops adenoma

secretes excessive PTH

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14
Q

What are the consequences of excessive PTH secretion in primary hyperparathyroidism?

A

Serum calcium rises

Serum phosphate falls

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15
Q

What is the cause of secondary hyperparathyroidism?

A

All four parathyroid glands undergo hyperplasia

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16
Q

Secondary hyperparathyroidism is seen in patients with?

A

Vitamin D deficiency

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17
Q

What are the causes of vitamin D deficiency?

A

Dietary - reduced intake

Environmental - reduced exposure to sun, darker skin

Chronic kidney failure

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18
Q

Why does chronic kidney failure cause vitamin D deficiency?

A

Failure of second hydroxylation reaction

25-hydroxyvitamin D —–> calcitriol

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19
Q

How does vitamin D deficiency affect serum calcium levels?

A

Reduced calcium absorption

low serum calcium levels

20
Q

How does vitamin D deficiency affect PTH levels?

A

Low serum calcium levels

causes PTH levels to rise

21
Q

What are the consequences of raised PTH levels?

A

Calcium mobilised from bone

to increase serum calcium levels

22
Q

What are the symtpoms of vitamin D deficiency?

A

Bone pain due to osteomalacia with vitamin D deficiency

Bone pain due to renal osteodystrophy with chronic kidney failure

23
Q

What are the symptoms of primary hyperparathyroidism?

A

Moans - tired, depressed

Groans - constipation, peptic ulcers, pancreatitis

Stones - kidney stones, polyuria

Bones - bone pain

24
Q

What causes polyuria in primary hyperparathyoidism?

A

Impaired sodium and warer reabsorption

due to kidney stones

25
Q

How does hypercalcaemia affect neurone membrane depolarisation?

A

High calcium makes outside of neurone relatively more positive
raises threshold for depolarisation
suppresses depolarisation

26
Q

How does hypocalcaemia affect neurone membrane depolarisation?

A

Low calcium makes outside of neurone relatively less positive
reduced threshold for depolarisation
neurone membrane more excitable

27
Q

What is classed as severe hypercalcaemia?

A

Serum calcium levels more than >3mM

28
Q

What are the symptoms of severe hypercalcaemia?

A

Lethargy, weakness

Confusion

Coma

Renal failure

Polyuria

29
Q

How does polyuria affect hypercalcaemia?

A

Leads to dehydration

which exacerbates the hypercalcaemia

30
Q

How is severe hypercalcaemia treated?

A

Rehydration

31
Q

Hypocalcaemia is seen most commonly in what group of patients? Why?

A

Post total thyroidectomy patients

because of accidental removal of parathyroid glands

32
Q

When do symptoms of hypocalcaemia develop?

A

When serum calcium falls below 2.10 mmol/L

Within 6 hours of thyroidectomy even

33
Q

What are the symptoms of hypocalcaemia?

A

Tingling around mouth, in fingers

Carpopedal spasms - spasms of hands and feet

34
Q

What is a sign of hypocalcaemia?

A

Chvostek’s sign - tapping over facial nerve gives facial twitching

35
Q

How can hypocalcaemia be fatal?

A

Laryngeal muscle tetany

36
Q

How is bone density affected in osteoporosis?

A

Reduced bone density

37
Q

How is the mineral:matrix ratio affected in osteoporisis?

A

Normal mineral:matrix ratio

38
Q

How does osteoporosis occur?

A

Destruction of bone that has already been fully constructed

39
Q

What are the consequences of osteoporisis?

A

Brittle bones that are more prone to fracture

40
Q

How is the mineral:matrix ratio affected in osteomalacia?

A

Reduced mineral:matrix ratio

due to reduction in mineral content

41
Q

What is osteomalacia called in children?

A

Rickets

42
Q

What are the consequences of rickets?

A

Deformed bones

43
Q

What are the consequences of osteomalacia in adults?

A

Soft bones, prone to bending

44
Q

What are the causes of osteomalacia/rickets?

A

Vitamin D deficiency

45
Q

What are the symptoms of osteomalacia in adults?

A

Bone pain

Muscle weakness

46
Q

What are the risk factors of osteoporosis?

A

Post-menopausal women

Low BMI

Long-term oral steroid use

Smoking, heavy drinking

Prolonged inactivity

47
Q

Which bones are more commonly fractured in osteoporosis?

A

Hip fractures

Wrist fractures

Vertebral fractures

Endocrinology (14 decks)

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