Hypercalcaemia Flashcards
What is hypercalcaemia?
Serum corrected calcium concentration > 2.6 mmol/L
Causes of hypercalcaemia?
- Primary HT
- Malignancy
- XSive Vit D or granulomatous disease
- Familial hypocalciuric hypercalcaemia
- High turnover: Pagets, thyrotoxic
- Tertiary Hyperparathyroidism
How does hypercalcaemia generally present?
- Bones, stones, abdominal groans and psychic undertones
- Bone pain
- Kidney stones
- Abdo pain
- Psychiatric disturbance
Acute presentation of hypercalcaemia?
Thirst
Dehydration
Confusion
Polyuria
Chronic presentation of hypercalcaemia?
Myopathy Fractures Osteopenia HT Pancreatitis DU Renal calculi
What hormone is investigated in Hypercalcaemia?
PTH
If PTH is high or normal in hypercalcaemia what must be considered?
-Primary/tertiary hyperparathyroidism
What to investigate next if PTH is high/normal?
-Investigate urinary calcium
High urinary calcium: think primary hyperthyroidism
Low urinary calcium: family hypo-uric hypercalcaemia
What to do if PTH is low?
- Look at ALP
- If high: Mets, sarcoidosis, thyrotoxicosis
- If low: Myeloma, Vit D toxicosis
What to consider if PTH is low?
Bone pathology
How to treat acute hypercalcaemia?
Fluids
- rehydrate with 0.9% saline 4-6l in 24h
- Consider loop diuretics once rehydrated
- Bisphosphonates
- Steroids
- Chemotherapy
What is familial hypocalciuric hypercalcaemia?
-Rare autosomal dominant condition which causes mild hypercalcaemia
What causes familial hypocalciuric hypercalcaemia?
Mutation in the calcium sensing receptor of the parathyroid cells- causing a reset of the sensing mechanism to a higher level of calcium
Characteristics of familial hypocalciuric hypercalcaemia?
- Mild hypercalcaemia
- Hypocalciuria
Test for familial hypocalciuric hypercalcaemia?
Genetic screening can be done if it is suspected
