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Renal and Urology > Disorders of Calcium Homeostasis > Flashcards

Disorders of Calcium Homeostasis Flashcards

1
Q

what rhyme is used for the symptoms of hypercalcaemia

A

stones
bones
abdominal moans
psychic groans

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2
Q

clinical manifestations of hypercalcaemia

A

muscle weakness
anorexia
nausea
mood change
depression
impaired water concentration in kidneys
renal stone formation
bone disease
abdominal pain
ECG changes - shortened QT interval, AF

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3
Q

what ECG changes are associated with hypercalcaemia

A

shortened QT interval
AF

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4
Q

causes of factitious hypercalcaemia

A

venous stasis (e.g. due to tourniqué)
dehydration
IV albumin

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5
Q

what is factitious hypercalcaemia

A

high Ca due to high plasma albumin
non-pathological

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6
Q

what is the difference between primary, secondary and tertairy hyperparathyroidism

A

1 - autonomous and innappropriate overproduction of PTH leading to hypercalcaemia
2 - appropriate increase in PTH in response to hypocalcaemia
3 - where a secondary overactive gland becomes overactive

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7
Q

cell appearance in biopsy in normal parathyroid compared to abnormal

A

normal - heterogenous cells
abnormal - homogenous cells

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8
Q

what features could be seen in xrays of someone with hyperparathyoridism

A

kidney stones
osteopenia

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9
Q

what will Ca and PTH levels be in primary hyperparasthyroidism

A

raised Ca
inappropriately raised PTH (should be low if Ca is high)

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10
Q

serum phosphate and bicarbonate levels in primary hyperparathyroidism

A

low due to increased renal excretion

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11
Q

what can be used for more difficult diagnoses of primary hyperparathyroidism

A

parathyroid imaging scan - using radioisotope

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12
Q

treatment of primary hyperparathyroidism

A

acutely rehydration and drugs
surgery to remove tumour
unless mild or can’t tolerate surgery - then drugs and monitoring of Ca and PTH levels

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13
Q

drugs for hypercalcaemia

A

bisphosphonates
furosemide
calcitonin (short term)
glucocorticoids

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14
Q

most common cause of hypercalcaemia in hospitalised patients

A

malignant disease

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15
Q

why is malignant disease a common cause of hypercalcaemia

A

endocrine factors secreted by malignant cells act on the bone
metastatic tumour deposits in bone locally which stimulates bone resorption via osteoclast activation

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16
Q

most common type of cancer to cause hypercalcaemia

A

lung
breast
multiple myeloma
(more likely to metastasise to bone)

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17
Q

what endocrine factors are involved in malignant hypercalcaemia

A

solid tumours may secrete PTH-related peptide which is similar in structure and function to PTH
some tumours synthesise calcitriol

18
Q

clinical manifestations of hypercalcaemia of malignancy

A

abundance of plasma cells in biopsy
pepperpot skull due to bone resorption
weak bones which break easily

19
Q

Ca, PTH, phosphate and alkaline phosphatase levels in malignant hypercalcaemia

A

Ca high
PTH low
phosphate high
alkaline phosphatase high

20
Q

treatment of malignant hypercalcaemia

A

rehydration
drugs to lower calcium (e.g. bisphosphonates)
treat cancer

21
Q

causes of hypercalcaemia

A

primary hyperparathyroidism
cancer
granulomatous disease (e.g. sarcoidosis)
exogenous vitamin D excess
FHH
drugs (e.g. lithium, thiazide diuretics)
endocrine disease (e.g. thyrotoxicosis, Addison’s)
immobilisation

22
Q

what part of the body is usually affected in sarcoidosis

A

lungs (90%)
skin (10%)

23
Q

Ca and PTH levels in sarcoidosis

A

Ca - high
PTH - normal

24
Q

how does sarcoidosis cause high Ca

A

vitamin D is hydroxylated in the granulomas
so more Ca absorbed

25
Q

what does FHH stand for

A

familial hypocalciuric hypercalcaemia

26
Q

what is FHH

A

Ca sensor on PT glands less sensitive to Ca suppression
so altered set point for PTH and Ca interaction
PTH levels high normal or slightly high
high plasma Ca
low urine Ca

27
Q

clinical manifestations of hypocalcaemia

A

numbness
parastheasia
anxiety
fatigue
muscle cramps
carpo-pedal spasm
bronchial or laryngeal spasm
seizures
personality change
mental confusion
psychoneurosis
impaired intellectual ability
ECG changes (long QT interval)
eye problems

28
Q

what characteristic do hypocalcemia symptoms have

A

due to increased muscular excitability

29
Q

what is Chvostek’s sign and what is it a sign of

A

contraction of eye mouth or nose when tapping along facial nerve
hypocalcaemia

30
Q

what is Trousseau’s sign and what is it a sign of

A

anterior lower arm muscles contracting when the brachial artery is occluded for 3 minutes
hypocalcaemia

31
Q

what is factitious hypocalcaemia

A

low calcium as a consequence of low plasma albumin

32
Q

causes of facitious hypocalcaemia

A

malnutrition/malabsorption (protein deficiency in diet)
liver disease (reduced liver synthesis)
nephrotic syndrome (albumin lost in urine)

33
Q

causes of hypocalcaemia

A

vitamin D deficient/lack of vitamin action
- lack of sunlight
- inadequate dietary source
- malabsorption
- CKD

34
Q

why does low vit D cause bone disease

A

low vit D → low Ca → PTH rise → increased bone resorption
also bone that is laid down is not adequately calcified

35
Q

Vit D, Ca, PTH, phosphate and ALP levels in vit D deficiency

A

vit D low
Ca low
PTH high
phosphate low
ALP raised

36
Q

rickets is called what in adults

A

osteomalacia

37
Q

causes of hypoparathyroidism

A

surgical damage/removal
suppressed secretion (e.g. low Mg or maternal hypercalcaemia)
inherited developmental parathyroid problems
genetic disorders

38
Q

Ca and PTH in hypoparathyroidism

A

low Ca
inappropriately low PTH

39
Q

treatment of hypocalcaemia

A

IV/oral calcium
IM or oral vit D
close monitoring of plasma calcium

40
Q

are there changes to Ca in osteoporosis

A

no

41
Q

how is osteoporosis investigated

A

DEXA scan

42
Q

histology of bone in osteoporosis vs osteomalacia

A

osteoporosis - normal formation but just less of it
osteomalacia - uncalcified osteiod (bone matrix)

Renal and Urology (16 decks)

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