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Medicine & Surgery: Endocrinology > Calcium & Vitamin D > Flashcards

Calcium & Vitamin D Flashcards

1
Q

What electrolyte imbalance could be causing these symptoms?
Bone pain, renal stones, groans, psychic moans, abdominal pain, vomiting, polyuria, polydipsia, depression, anorexia, weight loss, tiredness, hypertension, confusion.

A

Hypercalcemia

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2
Q

What is the abnormality present on an ECG in someone with hypercalcemia?

A

Short QT complex

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3
Q

What are the causes of hypercalcemia?

A
  1. Malignancy from bone metastases, myeloma, PTHrP
  2. Primary hyperparathyroidism
  3. Sarcoidosis, FHH
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4
Q

What are the typical blood test results in hypercalcemia?

A
  1. High phosphate, ALP indicates malignancy

2. High PTH indicates hyperparathyroidism

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5
Q

What is the treatment for hypercalcemia?

A
  1. IV saline
  2. Bisphosphonate - pamidronate
  3. Chemotherapy in malignancy, prednisolone in sarcoidosis
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6
Q

What electrolyte imbalance could be causing these symptoms?

Cramps, numbness, paraesthesia, spasms, seizures, Trousseau’s sign, Chvostek’s sign.

A

Hypocalcaemia

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7
Q

What is Trousseau’s sign and what does it indicate?

A
  1. Blood pressure cuff inflated, causes spasm in hand at wrist, MCP, IP
  2. Hypocalcaemia
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8
Q

What is Chvostek’s sign and what does it indicate?

A
  1. Tap facial nerve anterior to ear, contraction of ipsilateral facial muscles.
  2. Hypocalcaemia
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9
Q

What are the causes of hypocalcaemia if phosphate is high?

A

CKD, low Mg, hypoparathyroidism

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10
Q

What are the causes of hypocalcaemia if phosphate is normal or low?

A

Vitamin D deficiency or osteomalacia

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11
Q

What is the treatment for hypocalcaemia?

A
  1. Mild - oral calcium
  2. CKD - calcitriol, phosphate binders
  3. Severe - 10ml 10% calcium gluconate
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12
Q

What is the underlying histology in primary hyperparathyroidism?

A

80% solitary adenoma, 20% hyperplasia of the gland.

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13
Q

What signs/symptoms might someone with primary hyperparathyroidism have?

A
  1. Hypercalcaemia - weak, polydipsia, polyuria, renal stones, abdominal pain, pancreatitis, duodenal ulcers.
  2. Bone resorption - pain, fractures, osteopenia, osteoporosis
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14
Q

What are the findings of investigations in primary hyperparathyroidism?

A
  1. High calcium and parathyroid hormone
  2. Low phosphate, increased ALP from bone
  3. Raised 24-hour urinary calcium excretion
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15
Q

What is the treatment of primary hyperparathyroidism?

A
  1. Mild - increase fluid intake

2. Severe - removal of adenoma

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16
Q

What is the effect of secondary hyperparathyroidism on serum calcium and parathyroid hormone?

A
  1. Low calcium

2. Raised PTH

17
Q

What are the causes and treatment for secondary hyperparathyroidism?

A
  1. Causes - low vitamin D, CKD

2. Treatment - phosphate binders, vitamin D

18
Q

What is the effect of tertiary hyperparathyroidism on serum calcium and parathyroid hormone?

A
  1. High calcium

2. Very high PTH

19
Q

What is the main cause of tertiary hyperparathyroidism

A

Often occurs after prolonged secondary hyperparathyroidism (seen in CKD)

20
Q

What is malignant hyperparathyroidism?

A
  1. Parathyroid hormone releasing peptide produced by squamous cell lung cancer, breast cancer, and renal cell carcinoma.
  2. PTH is low, PTHrP is raised
21
Q

What causes primary hypoparathyroidism, what is the effect on calcium and phosphate, and how is it treated?

A
  1. Low PTH due to gland failure - autoimmune, congenital
  2. Low calcium, high/normal phosphate
  3. Calcium, calcitriol
22
Q

What are the causes of secondary hypoparathyroidism?

A

Radiation, surgery, hypomagnesaemia.

23
Q

What is pseudohypoparathyroidism, what is the effect on calcium and parathyroid hormone, and how is it treated?

A
  1. Failure of cell to respond to PTH - short 4th and 5th metacarpals, round face, short stature, reduced IQ.
  2. Low calcium, raised/normal PTH
  3. Calcium and calcitriol
24
Q

What is the difference between pseudohypoparathyroidism and pseudopseudohypoparathyroidism?

A

Pseudopseudohypoparathyroidism is the same as pseudohypoparathyroidism but has normal biochemistry.

Medicine & Surgery: Endocrinology (12 decks)

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