Hypercalcaemia

Question 1

D?

Answer 1

A serum calcium ion conc of>2.6mmol/L on two occasions.

Question 2

ddx?

Answer 2

• Primary parathyroidism
• Lithium
• Ectopic PTH
• MM
• Mets to bone
• Breast cancer
• Vit D intoxication
• Granulomatous disease
• Lymphoma
• Hyperthyroidism
• Addison's
• Drugs
Renal failure

Question 3

Epidemiology?

Answer 3

Age: Elderly
Sex: Female
Ethnicity:
Prevalence:

Question 4

Aetiology?

Answer 4

• Primary hyperparathyroidism
• Malignancy
• Granulomatous disease
• Immobilisation
• Hyperthyroidism
• Hypercalcaemia
• Drugs

Question 5

CP?

Answer 5

• Bone pain and skeletal deformities
• Osteoporosis
• Drowsiness, delirium and coma
• Fatigue and weakness
• Impaired conc and memory
• Depression, anxiety, irritability and psychosis
• Neurological signs
• N and V, weight loss, pain, pancreatitis
• Renal colic
• DI
• Renal impairment
• HT
• Shortened QT interval
• Arrhythmias
• Flushing and itching

Question 6

Pathophysiology?

Answer 6

See table

Question 7

I-first line?

Answer 7

exam

Question 8

I-second line?

Answer 8

Serum calcium blood test
• Repeat one week later
• Mild—adjusted calcium concentration is 2.6–3.00mmol/L.
•Moderate—adjusted calcium concentration is 3.01–3.40mmol/L.
• Severe—adjusted calcium concentration is greater than 3.40mmol/L.

Question 9

I-third line?

Answer 9

• FBC-anaemia or malignancy
• ESR/CRP-malignancy or granulomatous conditions
• eGFR and creatinine-assess for kidney disease
• Serum and protein electeophoresis-exclude MM
• LFTs-liver disease
• TFTs-thyrotoxicosis
• PTH
• Vit D
• Serum cortisol-Addisons
• Urinary A:Cr
• CXR-TB

Question 10

M-severe?

Answer 10

• Arrange ED admission if severe symptoms
• IV fluids
• IV bisphosphonates
• Loop diuretics
• Calcitonin

Question 11

M-mod?

Answer 11

• Refer under 2WW
• Exclude/Manage underlying cause
• Parathyroid surgery
• Vitamin D correction
• Calcitonin, calcimetric drugs (cinacalet),
• anti-resorptive agents- desunomab
• Bisphosphonates
• Glucocorticoid therapy if granulomatous or lymphoma

Question 12

M-Follow-up

Answer 12

• Monitor serum calcium
• Monitor bone density
• Monitor renal and CVS function
Lifestyle measures

Question 13

P?

Answer 13

• Depends on underlying cause

Malignancy and hyperparathyroidism have worse prognoses

Question 14

C?

Answer 14

• AKI
• Coma
• Acute pancreatitis
Arrhythmias