Disorders of Calcium Flashcards
Triad of Kidney stones, bone disease, peptic ulcer or pancreatitis High blood calcium with high PTH Blood phosphorous usually low 24 h urine calcium high or high normal Bone mineral density low
Primary hyperparathyroidism
Fatigue, confusion, depression, lethargy, coma, polyurethane, nocturia, constipation, pancreatitis, dyspepsia, weakness
General symptoms of hypercalcemia
Hypercalcemia, low blood phosphate and suppressed PTH
Hypercalcemia of malignancy due to PTHrP
High blood calcium, low PTH, high normal or elevated phosphate
Low vitamin d
Hypercalcemia of malignancy with cytokines
High calcium, low PTH, high blood phosphate
Vitamin d toxicity
PTH high normal, low urinary calcium
Familial hypocalciuric hypercalcemia
Don’t remove glands - it will just recur
Low blood calcium, high phosphate, low PTH
Hypoparathyroidism
Low calcium, high phosphorous, high PTH
Psuedohypoparathyroidism
Low calcium and low phosphorous in blood
Lack of vitamin d
Decreased 25 OHD
Decreased 1,25(OH)2-D (kidney disease, 1alpha hydroxylase deficiency)
Low calcium and phosphorous, high 1,25(OH)2D
Resistance - inactivating mutation of vitamin d receptor causing hypocalcemia
Neuromuscular excitability - chvosteks and trousseaus Muscle cramps the tetany Paresthesia Laryngo and bronchospasm Seizure Arrhythmia
Signs and symptoms of hypocalcemia
What are the causes of osteomalacia?
Vitamin d deficiency or resistance
Hypophosphatemia - FGF 23 increase renal loss and suppresses vitamin d
Drug induced - anticonvulsants enhance catabolism of vitamin d, phosphate binders (aluminum)
Diffuse bone pain, muscle tenderness and weakness, waddling gait, fractures and psuedofractures in usual and unusual locations (ribs, sternum, scapula, pelvis, femoral shafts, metatarsals - not in osteoperosis)
Osteomalacia
Decreased growth, widening of epiphysis, rachitic rosary, deformation of bones, tooth enamel defects
Rickets
What lab values are seen in osteomalacia?
Elevated alk phos and/or PTH
Low blood calcium and/or phosphate
