Hypercalcaemia & Hyperparathyroidism Flashcards
what are the typical symptoms associated with hypercalcaemia
bony pain, kidney pain, abdo pain, psychiatric disturbance
bones, stones, abdominal groans, psychiatric moans
what can patients acute hypercalcaemia present with
thirst, dehydration, confusion, polyuria
what signs/symptoms can occur with chronic hypercalcaemia
myopathy, fractures/osteopenia, depression, hypertension, kidney stones, pancreatitis
what are the 2 main causes of hypercalcaemia
primary hyperparathyroidism and malignancy
what are some of the less common causes of hypercalcaemia
drugs(eg vit D), granulomatous disease, familial hypocalciuric hypercalcaemia(FHH)
what is the upper limit range of corrected calcium
2.55, anything over is hypercalcaemia
what is the most useful biochemical test in diagnosis of the cause of hypercalcaemia
parathyroid hormone(PTH)
what are the different hypercalcaemia causes that result in high PTH
primary(or tertiary) hyperparathyroidism, or familial hypocalciuric hypercalcaemia(FHH)
what is the cause of hypercalcaemia with a low PTH
not hyperparathyroidism, likely malignancy
how can differentiation between hyperparathyroidism and FHH be made
hyperparathyroidism = increase urine Ca excretion FHH = decreased urine Ca excretion
what further diagnostic biochemical test is done after establishing hypercalcaemia with low PTH
ALP
if ALP is raised in hypercalcaemia with low PTH, what are the differential diagnosis
metastases, sarcoidosis, thyrotoxicosis
if ALP is low in hypercalcaemia with low PTH, what are the differential diagnosis
myeloma, vit D toxicity, Milk-Alkali syndrome
what 3 things must be present in diagnosis of primary hyperparaathyroidism
raised serum Ca2+, raised serum PTH(or inappropriately normal), increased urine Ca2+ excretion
what different mechanisms can cause hypercalcaemia in malignancy
metastatic bone destruction(tumour in bon releasing Ca), PTHrp from solid tumours, osteoclast activating factors(breakdown bone)
what investigations can be done in the diagnosis of hypercalcaemia caused by malignancy
diagnosis involves; raised Ca2+, raised ALP, and imagery such as X-ray, CT, MRI, PET, isotope bone scan
what initial treatment is usually used for acute hypercalcaemia
fluids rehydrate with 0.9% saline 4-6L in 24 hours, and bisphosphonates
what other treatments are considered for treatment of acute hypercalcaemia
loop diuretics once rehydrate(avoid thiazides), steroids occasionally(eg sarcoidosis), chemo if malignancy
what are the different treatment options for primary hyperparathyroidism
surgery(parathyroidectomy), or cinacalcet
what type of drug is and when would Cinacalcet be used as treatment for primary hyperparathyroidism
calcium mimetic, can be used if unfit for surgery, approved for tertiary hyperparathyroidism and parathyroid carcinoma
what are the indications for a parathyroidectomy in primary hyperparathyroidism
if patients has; end organ damage, very high serum Ca2+ >2.85mmol/l, <50y/o, eGFR <60mL/min
what end organ damage can occur in primary hyperparathyroidism
bone disease, gastric ulcers, renal stones, osteoporosis
what is the difference between primary and secondary hyperparthyroidism
primary = primary overactivity of parathyroid gland, high PTH, high Ca secondary = response to low Ca or vit D, high PTH, low Ca
what genetic syndromes is hyperparathyroidism involved in
MEN 1/2 and familial isolated hyperparthyroidism
describe the pathophysiology of FHH
calcium-sensing receptor becomes much less sensitive, so no PTH inhibition, high serum Ca, low urine Ca
describe the biochemistry seen in primary hyperparathyroidism
high Ca, high PTH, normal/raised ALP, low phosphate
describe the biochemistry seen in hypercalcaemia caused by malignancy
high Ca, low PTH, very high ALP, normal phosphate
