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Endocrine System > Clinical Aspects of Hypercalcaemia > Flashcards

Clinical Aspects of Hypercalcaemia Flashcards

1
Q

What are the different levels of acute hypercalcaemia?

A
  • < 3mmole/L - asymptomatic
  • 3-3.5mmole/L - well tolerated if risen slowly, but may be symptomatic requiring prompt treatment
  • > 3.5mmole/L - urgent correction and risk of dysrhythmia and coma
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2
Q

What are the four categories of causes of hypercalcaemia?

A
  • Parathyroid mediated
  • Non-parathyroid mediated
  • Medication
  • Miscellaneous
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3
Q

What are the parathyroid causes of hypercalcaemia?

A
  • Primary hyperparathyroidism (sporadic)
  • Familial hypocalciuric hypercalcaemia
  • Tertiary hyperparathyroidism (renal failure)
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4
Q

What are the non-parathyroid causes of hypercalcaemia?

A
  • Hypercalcaemia of malignancy
  • Vit D intoxication
  • Chronic granulomatous disorders
  • Chronic granulomatous disorders (sarcoid, TB)
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5
Q

What are the medications that can cause hypercalcaemia?

A
  • Thiazide diuretics
  • Lithium
  • Teriparatide
  • Excess Vit A
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6
Q

What are the miscellaneous causes of hypercalcaemia?

A
  • Hyperthyroidism
  • Acromegaly
  • Pheochromocytoma
  • Adrenal insufficiency
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7
Q

What are the clinical features of hypecalcaemia?

A

Renal:
• Polyuria (urine ++)
• Polydipsia (thirst ++)
• Nephrolithiasis (kidney stones)

GI:
• Anorexia
• Nausea + vomiting
• Constipation

MSK:
• Muscle weakness
• Osteopenia/osteoporosis

  • Decreased concentration
  • Shortened QT interval
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8
Q

What is the saying to remember clinical features of hypercalcaemia?

A

Bone, stones, groans and psychic moans

  • Nausea, vomiting (groans)
  • Personalty changes
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9
Q

What are the two main causes of hypercalcaemia?

A

Primary hyperparathyroidism (sporadic) or Hypercalcaemia of malignancy

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10
Q

What do you need to look for in the history and examination of hypercalcaemia?

A 
History:
• Symptoms of  hypercalcaemia
• Systemic enquiry
• Medications
• FH

Examination:
• Lymph nodes
• Concerns about malignancy (breast, lung etc.)

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11
Q

What investigations are used for hypercalcaemia?

A
  • U+Es
  • Ca
  • PO4
  • Alk phos
  • Myeloma screen
  • Serum ACE (screen for sarcoidosis)
  • PTH!!
  • Consider ECG
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12
Q

After confirming hypercalcaemia, what is the first investigation?

A
  1. Recheck Ca and albumin, ensure corrected calcium calculated
  2. Check PTH
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13
Q

If PTH is normal or high, what are possible causes?

A

Primary hyperparathyroidism or Familial hypocalciuric hypercalcaemia (rare) or tertiary hyperparathyroidism (renal failure)

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14
Q

If PTH is low, what are possible causes?

A

Malignancy or drug causes

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15
Q

What are the features of primary hyperparathyroidism ?

A
  • Most are asymptomatic
  • Most are sporadic but linked to neck irradiation or prolonged lithium use
Causes:
• Parathyroid adenoma
• Four gland hyperplasia
(• MEN type 1 or 2A)
(• Parathyroid carcinoma)
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16
Q

What are the investigation of primary hyperparathyroidism?

A
  • Ca, PTH
  • U+Es (renal function)
  • Abdominal imagining (renal calculi)
  • DEXA: osteoporosis
  • 24hr urine collection for Ca (exclude FHH)
  • Vit D
17
Q

What abdominal imaging is used for primary hyperparathyroidism?

A
  • (Para)thyroid ultrasound
  • Nuclear medicine scan - give tracer and abnormal gland will take it up
  • 4D-CT
18
Q

When is surgery indicated in primary hyperparathyroidism?

A
  • Symptoms due to hypercalcaemia
  • Serum Ca
  • Osteoporosis
  • Kidney stones
  • < 50yrs
19
Q

What is the treatment for primary hyperparathyroidism?

A
  • Generous fluid intake (for polyuria)
  • Cinacalet (mimics effect of Ca on chief cells to decrease release of PTH)
  • Surgery
20
Q

What is Familial Hypocalciuric Hypercalcaemia?

A

Autosomal dominant disorder of the calcium sensing receptor

PTH may be normal or slightly elevated, and high Ca as not excreted via kidneys

21
Q

What is the investigation and treatment of FHH?

A

Positive family history, screen young family members for diagnosis.

Benign, no therapy indicated.

22
Q

What must be excluded before surgery for hyperparathyroidism?

A

Familial hypercalciuric hypercalcaemia

23
Q

What are the two types of multiple endocrine neoplasia?

A

MEN type 1 and type 2A

24
Q

What can multiple endocrine neoplasia cause?

A

Primary hyperparathyroidism

25
Q

What is the management of hypercalcaemia?

A
  1. Rehydration
  2. IV bisphosphonates (zolendronic acid)
  3. Second line management
26
Q

What is the second line management of hypercalcaemia?

A
  • Glucocorticoids
  • Calcitonin
  • Calcimimetics
  • Parathyroidectomy

Endocrine System (29 decks)

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