Endocrine - Calcium disorders

Question 0

Causes of Hypercalcemia?

Answer 0

#Vitamin D intoxication (milk alkali)
#Sarcoidosis
#Thiazide diuretics
#Hyperthyroidism
#Multiple myeloma or metastatic disease

Question 1

Most common cause of Asymptomatic hypercalcemia?

If patient presents with severe, acute symptomatic hypercalcemia, consider?

Answer 1

Primary hyperparathyroidism

Malignancy releasing PTrH

Question 2

Presentation of hypercalcemia?

Answer 2

#Neuro – confusion, stupor, lethargy
#Cardio – short QT and hypertension
#G.I. – SBO-like (constipation, anorexia, nausea/vomiting, Abdominal pain) and Peptic ulcer disease
#Bone – osteoporosis
#Renal – nephrolithiasis, diabetes insipidus, renal insufficiency

Question 3

Treatment for acute hypercalcemia?

If Patient continues to be hypercalcemic?

If patient is in renal failure?

Answer 3

#Saline hydration
#Bisphosphonates

Calcitonin

Dialysis

Question 4

Causes of primary hyperparathyroidism?

Answer 4

#Solitary adenoma
#Hyperplasia
#Malignancy

Question 5

Primary hyperparathyroidism presentations?

Answer 5

Usually asymptomatic, long-term manifestations include

#osteoporosis
#nephrolithiasis and renal insufficiency
#Muscle weakness
#Anorexia, nausea/vomiting, Abdominal pain
#Peptic ulcer disease

Question 6

Why does hyperparathyroidism cause peptic ulcer disease?

Answer 6

Calcium stimulates gastrin

Question 7

Diagnostic tests to suggest hyperparathyroidism?

Answer 7

#High calcium and PTH
#Low phosphate
#High chloride
#High BUN/creatinine

EKG with short QT

Question 8

Treatment of hyperparathyroidism? If not an option?

Answer 8

Surgical removal

Cinecalcet

Question 9

Primary Hypoparathyroidism is most often due to? Other causes of hypoparathyroidism include?

Answer 9

Prior neck surgery (thyroidectomy)

#hypoMg (Less PTH release and urine loss of Ca)
#renal failure (no active vitamin D)
#Vitamin D deficiency
#Fat malabsorption
#Low albumin

Question 10

For every point decreased in albumin, effect on Ca? Why no symptoms?

Answer 10

Drops by 0.8; free calcium level is normal

Question 11

Presentation of hypocalcemia?

Answer 11

#Chovstek's sign
#Carpopedal spasm
#Perioral numbness
#Seizures
#Tetany (Trousseau sign)

Question 12

Diagnostic tests that suggests hypocalcemia?

Answer 12

#Prolonged QT
#Cataracts on slit lamp exam