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Clinical calcium homeostasis Flashcards

1
Q

Dietary sources of calcium

A 
fish where you eat the bones eg sardines 
milk, cheese, dairy products 
tofu
green leafy veg (not spinach)
soy beans 
bread 
nuts
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2
Q

4 functions of calcium

A

neurotransmitter release
bone formation
muscle contraction
cell division and growth

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3
Q

What is important to remember when measuring a patient’s calcium?

A

FREE calcium in blood

need to consider albumin levels

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4
Q

Sources of vitamin D

A

sunlight
fortified cereals and fat spread
oily fish
eggs

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5
Q

What cells in the parathyroid respond directly to changes in calcium concentration?

A

chief cells

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6
Q

What are the receptors which help the parathyroid gland sense changes in calcium concentration?

A

calcium sensing receptor

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7
Q

Is PTH secreted in response to high or low plasma calcium?

A

low

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8
Q

Effects of PTH

A

direct = bone and renal tubule reabsorption

mediates renal conversion to active vitamin D

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9
Q

What 2 organs play a role in calcitriol metabolism?

A

liver

kidneys

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10
Q

Why do some people require supplements with the already active vitamin D?

A

renal failure

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11
Q

Acute neuromuscular symptoms of hypocalcaemia

A 
muscle twitching 
paraesthesia 
chovstek's sign 
Troussea's sign
seizures 
laryngospasm and bronchospasm
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12
Q

Acute cardiac symptoms of hypocalcaemia

A 
prolonged QT interval 
arrhythmia 
heart failure 
hypotension 
papilloedema
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13
Q

Chronic signs/symptoms of hypocalcaemia

A 
ectopic calcification eg basal ganglia 
parkinsonism 
dementia 
dry skin 
abnormal dentition
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14
Q

Explain Chovstek’s sign

A

patient relaxes facial nerve and sat to the side of us
tap facial nerve anteriorly to ear
lip twitch –> all facial muscles spasm

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15
Q

Explain Trosseau’s sign

A

Blood pressure cuff around arm and pumped up to just past systolic pressure and left for 2-3 mins
as deflating the arm curves inwards and carpal spasm

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16
Q

Causes of hypocalcaemia

A 
disruption of parathyroid gland due to total thyroidectomy (temporary or permanent effects)
selective parathyroidectomy 
severe vitamin D deficiency 
Magnesium deficiency (PPI)
cytotoxic drug induced hypocalcaemia 
pancreatitis, blood transfusion
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17
Q

Low PTH hypoparathyroidism causes

A 
genetic 
post surgical 
autoimmune 
infiltration 
HIV 
radiation induced 
hungry bone syndrome
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18
Q

High PTH (secondary hyperparathyroidism) causes of low calcium

A 
vitamin D deficiency 
pseudohypoparathyroidism 
renal disease 
acute pancreatitis 
hypomagnesemia
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19
Q

Drugs which can cause hypocalcaemia

A

cinacalcet
inhibitors of bone resorption eg bisphosphonates
fluoride poisoning
phenytoin

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20
Q

Clues important in the diagnosis of hypocalcaemia

A

symptoms, vit D and calcium intake, neck surgery, FH, autoimmune, medication
neck surgery scars

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21
Q

Investigations for hypocalcaemia

A

ECG, serum calcium, albumin, phosphate, PTH, U+E’s, vitamin D, magnesium

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22
Q

If PTH is low/normal what can the causes of hypocalcaemia be?

A

magnesium deficiency

primary hypoparathyroidism or CSR defects

23
Q

If PTH is high what can the causes of hypocalcaemia be?

A

vitamin D deficiency
renal failure
pseudohypoparathyroidism
calcium deficiency

24
Q

5 causes of hypoparathyroidism

A 
surgery/ autoimmune - destruction 
agenesis 
infiltration 
reduced PTH secretion
resistance to PTH
25
When does pseudohypoparathyroidism present?
childhood
26
What is pseudohypoparathyroidism?
target organ - kidney, bone | unresponsive to PTH
27
3 classic characteristics of pseudohypoparathyroidism
hypocalcaemia increased PTH hyperphosphatemia
28
Characteristics of AHO
obesity, short stature, shortening of 4th and 5th metacarpal bones
29
What is shortening of 4th and 5ht metacarpal bones characteristic of?
AHO | pseudohypoparathyroidism
30
What is AHO without PTH or calcium abnormalities called?
pseudopseudohypoparathyroidism
31
Treatment for mild hypocalcaemia
oral calcium tablets vitamin D stop precipitating magnesium deficiency and replace
32
Treatment for severe hypocalcaemia
medical emergency IV calcium gluconate treat underlying cause
33
2 hydroxylated forms of vitamin D
calcitriol | alfacalcidal
34
Causes of hypercalcaemia
malignancy primary hyperparathyroidism MEN, vitamin D intoxication, FHH, thiazide diuretics, lithium, acromegaly
35
Saying for hypercalcaemia
stones, bones, groans and psychic moans
36
``` Clinical features of hypercalcaemia A - Renal B - GI C - CVS D - neurological E - MSK ```
A - nephrolithiasis, polyuria, polydipsia B - abdominal pain, constipation, anorexia, nausea and vomiting, pancreatitis, peptic ulcer, biliary calculi C - short QT interval, bradycardia, hypertension D - depression, reduced concentration, fatigue, confusion E - osteopenia/osteoporosis, bone pain
37
Clues in diagnosis of hypercalcaemia
symptoms, FHH, medications, systemic enquiry | lymph nodes, malignancy eg breast , lung
38
Investigations for hypercalcaemia
U+E, calcium, phosphate, myeloma screen, serum ACE, PTH, ECG
39
PTH high or normal hypercalcaemia cause
primary hyperparathyroidism
40
PTH low hypercalcaemia
malignancy | drug causes
41
Primary hyperparathyroidism epidemiology
female, 50-60, asymptomatic | few linked to lithium or neck irradiation
42
Most common cause of primary hyperparathyroidism
parathyroid adenoma | can also have 4 gland hyperplasia but MEN and carcinoma are rare
43
Investigations for primary hyperparathyroidism
``` calcium, PTH U+E, vitamin D abdominal imaging - renal calculi DEXA scan 24 hour urine collection for calcium to exclude FHH SESTAMIBI ultrasound ```
44
5 indications for parathyroid surgery
``` under 50 calcium more than 0.25mmol raised eGFR <60 or renal calculi osteoporosis - DEXA symptomatic ```
45
2 medical management of hypercalcaemia
fluids | cinacalcet - calcimetic
46
What does cincalcet do?
lead to fall in PTH by acting like calcium and therefore decrease calcium
47
Inheritance of FHH and what has gone wrong
autosomal dominant | CSR
48
Examples of malignancy leading to hypercalcaemia
squamous cell eg lung, cervix | breast, multiple myeloma, lymphoma
49
MEN type 1
primary hyperparathyroidism pituitary pancreatic
50
MEN type 2A
medullary thyroid cancer phaeochromocytoma hyperparathyroidism
51
Why is family history important in hyperparathyroidism?
MEN | FHH
52
2 primary management of hypercalcaemia
rehydration IV bisphosphonates second line management
53
List some second line managements in hypercalcaemia
glucocorticoids calcitonin calcimetics parathyroidectomy

Diabetes & Endocrinology (24 decks)

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