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Year 2 Diabetes & Endocrinology (JK) > Clinical calcium homeostasis > Flashcards

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
Q

When does pseudohypoparathyroidism present?

A

childhood

26
Q

What is pseudohypoparathyroidism?

A

target organ - kidney, bone

unresponsive to PTH

27
Q

3 classic characteristics of pseudohypoparathyroidism

A

hypocalcaemia
increased PTH
hyperphosphatemia

28
Q

Characteristics of AHO

A

obesity, short stature, shortening of 4th and 5th metacarpal bones

29
Q

What is shortening of 4th and 5ht metacarpal bones characteristic of?

A

AHO

pseudohypoparathyroidism

30
Q

What is AHO without PTH or calcium abnormalities called?

A

pseudopseudohypoparathyroidism

31
Q

Treatment for mild hypocalcaemia

A

oral calcium tablets
vitamin D
stop precipitating magnesium deficiency and replace

32
Q

Treatment for severe hypocalcaemia

A

medical emergency
IV calcium gluconate
treat underlying cause

33
Q

2 hydroxylated forms of vitamin D

A

calcitriol

alfacalcidal

34
Q

Causes of hypercalcaemia

A

malignancy
primary hyperparathyroidism
MEN, vitamin D intoxication, FHH, thiazide diuretics, lithium, acromegaly

35
Q

Saying for hypercalcaemia

A

stones, bones, groans and psychic moans

36
Q 
Clinical features of hypercalcaemia 
A - Renal 
B - GI 
C - CVS 
D - neurological 
E - MSK
A

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
Q

Clues in diagnosis of hypercalcaemia

A

symptoms, FHH, medications, systemic enquiry

lymph nodes, malignancy eg breast , lung

38
Q

Investigations for hypercalcaemia

A

U+E, calcium, phosphate, myeloma screen, serum ACE, PTH, ECG

39
Q

PTH high or normal hypercalcaemia cause

A

primary hyperparathyroidism

40
Q

PTH low hypercalcaemia

A

malignancy

drug causes

41
Q

Primary hyperparathyroidism epidemiology

A

female, 50-60, asymptomatic

few linked to lithium or neck irradiation

42
Q

Most common cause of primary hyperparathyroidism

A

parathyroid adenoma

can also have 4 gland hyperplasia but MEN and carcinoma are rare

43
Q

Investigations for primary hyperparathyroidism

A 
calcium, PTH 
U+E, vitamin D 
abdominal imaging - renal calculi 
DEXA scan 
24 hour urine collection for calcium to exclude FHH 
SESTAMIBI 
ultrasound
44
Q

5 indications for parathyroid surgery

A 
under 50 
calcium more than 0.25mmol raised 
eGFR <60 or renal calculi 
osteoporosis - DEXA 
symptomatic
45
Q

2 medical management of hypercalcaemia

A

fluids

cinacalcet - calcimetic

46
Q

What does cincalcet do?

A

lead to fall in PTH by acting like calcium and therefore decrease calcium

47
Q

Inheritance of FHH and what has gone wrong

A

autosomal dominant

CSR

48
Q

Examples of malignancy leading to hypercalcaemia

A

squamous cell eg lung, cervix

breast, multiple myeloma, lymphoma

49
Q

MEN type 1

A

primary hyperparathyroidism
pituitary
pancreatic

50
Q

MEN type 2A

A

medullary thyroid cancer
phaeochromocytoma
hyperparathyroidism

51
Q

Why is family history important in hyperparathyroidism?

A

MEN

FHH

52
Q

2 primary management of hypercalcaemia

A

rehydration
IV bisphosphonates
second line management

53
Q

List some second line managements in hypercalcaemia

A

glucocorticoids
calcitonin
calcimetics
parathyroidectomy

Year 2 Diabetes & Endocrinology (JK) (24 decks)

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