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Endocrinology > Hypercalcaemia > Flashcards

Hypercalcaemia Flashcards

1
Q

What are the 2 causes for 90% of hypercalcaemia?

A
  1. Hyperparathyroidism
  2. Malignancy
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2
Q

What are 7 less common causes of hypercalcaemia? ( There are more than 7 btw)

A
  1. High vitamin D
  2. Lithium
  3. Rhabdomyolyais
  4. Throtoxicosis
  5. Thiazides diuretics
  6. Adrenal insufficiency
  7. Phaeochromocytoma
  8. Sarcoidosis
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3
Q

High Calcium + High PTH OR PTH that is normal but >median reference range =?

A

Primary or Tertiary Hyperparathyroidism

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4
Q

High Calcium + Low PTH =?

A

Malignancy or other rare cause

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5
Q

What are 7 common symptoms?

A
  1. Polyuria
  2. Thirst
  3. Mood disturbances and confusion
  4. Renal impairment
  5. Arrythmias
  6. Pancreatitis
  7. Muscle weakness
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6
Q

Is peri oral tingling a sing of hypercalcaemia or hypocalcaemia?

A

Hypocalcaemia

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7
Q

What questions should you ask about the patient’s history if they have hypercalcaemia?

A
  1. Symptoms of hypercalcaemia
  2. Symptoms of Malignancy- weight loss, night sweats, cough
  3. Family history
  4. Drugs including supplements, OTC preparations.
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8
Q

What should you do on examining the patient with hypercalcaemia?

A
  1. Assess for cognitive impairment
  2. Look for underlying causes of malignancy – Respiratory, abdomen, breasts, lymph nodes.
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9
Q

What does the clinical picture look like in secondary hyperparathyroidism?

A

They will have a high PTH but will have a normal although calcium level.

The cause of secondary hyperparathyroidism is usually due to kidney, liver or bowel disease.

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10
Q

After rehydration, What are the common tests that should be done?

A
  1. U&Es
  2. Albumin
  3. PTH
  4. Myeloma screen
  5. 25-OH vitamin D concentrations
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11
Q

Describe the algorithm for investigating hypercalcaemia.

A
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12
Q

Describe the normal calcium regulatory pathway

A
  1. Low blood calcium levels stimulate PTH release.
  2. PTH release causes an overall increase in Calcium and a decrease in PO43-
    • Main function of PTH: Kidneys: It increases calcium and decreases PO43-.
    • Bones: It increases osteoclast activity - which releases calcium and PO43-
    • Stimulates the production of calcitriol.
  3. Calcitriol (Vitamin D that has been produced by the Liver and then activated by the kidneys)
    • Main function: Intestines: Increases Absorption of calcium and PO43-.
    • Inhibits PTH.
  4. ​And thus Blood Calcium Increases. (PO43- generally decreases)
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13
Q

Describe the normal calcitonin regulatory pathway.

A
  1. High Blood Calcium levels
  2. Calcitonin is released by C-Cells in the Thyroid gland.
    1. Bones: It increases calcium and PO43- deposition in bones.
    2. Kidneys: It increases excretion of calcium in kidneys.
    3. Intestines: Decreases calcium gut absorption.
  3. And thus, Calcium levels are lowered.
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14
Q

Are low or high phosphate levels of significance?

A

Hypophosphateaemia - is of little significance. Can be low in hyperparathyroidism.

Hyperphophataemia - commonly due to CKD.

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15
Q

What is the management for hypercalcaemia?

A
  1. Rehydration (3-4 litres a day)
  2. Bisphosphonates - take 2 to 3 days to work and reach maximal effect by 7 days.
  3. Other options
    • Calcitonin - quicker than bisphosphonates.
    • Steroids in sarcoidosis
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16
Q

A 70-year-old woman is referred by a GP colleague to the hospital with a breast lump.

She is asymptomatic but her investigations reveal:

  • Corrected calcium - 2.72 mmol/L (2.2-2.6)
  • Phosphate - 0.80 mmol/L (0.8-1.4)
  • Alkaline phosphatase - 110 U/L (45-105)
  • PTH concentration - 5.1 pmol/L (0.9-5.4)

What is the most likely diagnosis?

  • Boney Metastases
  • Chronic Vitamin D excess
  • Ectopic related peptide (PTHrp) secretion
  • Multiple Myeloma
  • Primary Hyperparathyroidism
A

Primary Hyperparathyroidism

  • Boney mets and multiple myeloma could have high calcium but would then have a low PTH.
  • Vitamin D Excess - would cause an elevated phosphate.
  • Ectopic PTHrp secretion - Not usually detected as part of PTH. PTH would therefore be low but then if you test for PTHrp the PTHrp would be high.
17
Q

..Describe another algorithm using albumin, phosphate and ALP.

A

Endocrinology (24 decks)

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