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Endocrine > Hypercalcaemia > Flashcards

Hypercalcaemia Flashcards

1
Q

What is Hypercalcaemia

A

Calcium levels <2.6

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2
Q

At what point does hypercalcamia need to be treated

A

> 3.0

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3
Q

What should be done if calcium levels are >3.5

A

Requires urgent correction due to risk of dysrhythmia and coma

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4
Q

What categories can the causes of hypercalcaemia be put into

A

Parathyroid mediated
Non-Parathyroid mediated
Medications
Miscellaneous

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5
Q

What are the most common parathyroid mediated cause of hypercalcaemia

A

Primary hyperparathyroidism (sporadic) (most common)

Multiple endocrine neoplasia (MEN)

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6
Q

What is the most common Non-Parathyroid mediated causes of hypercalcaemia

A

Hypercalcaemia of malignancy

Vitamin D intoxication

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7
Q

When should you consider medicine as a cause of hypercalcaemia

A

Medicines should be considered of there is a slow rise in calcium

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8
Q

Whats the most common medicine that can cause hypercalcaemia

A

Thiazide diuretics

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9
Q

What are the clinical features of Hypercalcaemia

A

Polyuria
Polydipsia
nephrolithiasis

Anorexia
Nausea and vomitting

Muscle weakness

Decreased concentration

Shortning of QT interval

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10
Q

Why is the rate of calcium increase important

A

Hypercalcaemia is generally better tolerated if the rate of increase has been slow.

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11
Q

What investigations should you do for hypercalcaemia

A

PTH (most important)

U&Es 
Ca  
PO4  
Alk phos  
Myeloma screen  
Serum ACE 
Consider ECG
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12
Q

What is first line treatment for hypercalcemia

A

Rehydration – 0.9% Saline 4-6 litres over 24 hours – Monitor for fluid overload – Consider dialysis if severe renal failure

After rehydration, intravenous bisphosphonates (take couple of days to work) – Zolendronic acid 4mg over 15 mins – Give more slowly and consider dose reduction if renal impairment – Calcium will reach nadir at 2-4 days.

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13
Q

What is Primary hyperparathyroidism

A

Primary hyperparathyroidism is a condition in which one or more of the parathyroid glands makes too much PTH.

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14
Q

What is the epidemiology of Primary hyperparathyroidism

A

Female: male = 3:1

Incidence peaks 50-60 years

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15
Q

Whats the causes of Primary hyperparathyroidism

A

85% parathyroid adenoma
15% four gland hyperplasia
<1% MEN type 1 or 2A
<1% parathyroid carcinoma

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16
Q

Whats the presentation of Primary hyperparathyroidism

A

Usually asymptomatic

17
Q

What is the aim of investigations for

Primary hyperparathyroidism

A

To confirm diagnosis then find affects of hypercalcaemia

18
Q

What investigations should be carried out for Primary hyperparathyroidism

A

Ca,

PTH

U&Es: check renal function

Abdominal imaging: renal calculi

DEXA: osteoporosis

Spot urinary calcium/creatinine ratio

24 hour urinary calcium:

19
Q

Why do you do a Spot urinary calcium/creatinine ratio

A

To exclude Familial hypocalciuric hypercalcaemia … A RARE MIMIC

20
Q

What is the treatment for primary hyperparathyroidism

A

SURGICAL – definitive treatment. Curates 95% of people.

Medical

21
Q

What are indications for surgery primary hyperparathyroidism

A

Presence of symptoms due to hypercalcaemia

High serum calcium

Osteoporosis

Reduced GFR or presence of kidney stones

<50 years

22
Q

What is the medical management of primary hyperparathyroidism

A

Generous fluid intake (2-3 l/day)

Vitamin D replacement Cinacalcet

23
Q

What is Cinacalcet

A

Acts as a calcimetic and mimics the effect of calcium on the calcium sensing receptor on Chief cells, this leads to a fall in PTH and subsequently calcium levels) – expensive

24
Q

What is Familial hypocalciuric hypercalcaemia (FHH)

A

Autosomal dominant disorder of the calcium sensing receptor (runs in families)

25
Q

How do you check for hypocalciuric hypercalcaemia (FHH)

A

It will present with Low urinary calcium levels (which should be high in primary hyperparathyroidism

26
Q

What is multiple endocrine neoplasia

A

Autosomal dominoant conditions that present with a group of associated endorcrine conditions.

27
Q

What should you think to suspect MEN type 1

A

Primary hyperparathyroidism
Pancreatic
Pituitary

28
Q

What should you think to suspect MEN type 2

A

Medullary thyroid cancer

Phaeochromocytoma Primary hyperparathyroidism

Endocrine (14 decks)

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