Hypercalcaemia

Question 1

causes

Answer 1

primary and tertiary hyperparathyroidism
malignancy
drugs (vitamin D, thiazides)
granulomatous disease (sarcoidosis, TB)
FHH
high turnover e.g. thyrotoxic, Paget's

Question 2

presentation

Answer 2

BUZZWORD= bones, stones, abdominal groans and psychic moans (hyperparathyroidism)

Question 3

acute presentation

Answer 3

thirst
dehydration
confusion
polyuria (calcium induces nephrogenic DI)
constipation
cardiac arrhythmias
muscle weakness

Question 4

chronic presentation

Answer 4

myopathy
osteopenia
depression
hypertension
pancreatitis
DU
renal calculi

Question 5

diagnosis

Answer 5

• raised serum calcium
• raised/normal serum PTH
• increased urinary calcium

Question 6

cause of malignancy with hypercalcaemia

Answer 6

metastatic bone destruction
PTHrp from solid tumours
osteoclast activating factors

Question 7

diagnosis of malignancy with hypercalcaemia

Answer 7

raised calcium
raised ALP
suppressed PTH
imaging

Question 8

management of hypercalcaemia

Answer 8

acute= fluid saline 4-6L in 24 hours
consider loop diuretics once rehydration (avoid thiazide as they retain calcium)
consider bisphosphonates and steroids
chemotherapy for malignancy

Question 9

genetics of familial hypocalciuric hypercalcaemia FHH

Answer 9

AD mutation of the calcium sensing receptor, no binding causes excess PTH

Question 10

what happens in FHH

Answer 10

the increased PTH causes increased reabsorption in the gut causing low calcium in urine and increased breakdown in bone increasing serum calcium which acts on the kidneys. this causes mild hypercalcaemia and reduced calcium excretion

Question 11

diagnosis of FHH

Answer 11

genetic screening