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CP3 @ UoN - Medicine & Surgery > Hypercalcaemia/Parathyroid Disease > Flashcards

Hypercalcaemia/Parathyroid Disease Flashcards

1
Q

How much of plasma calcium is bound to albumin?

A

40% (inactive)

Non-bound is ionized

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2
Q

What effect do acidotic states have on ionized calcium level?

A

Increase ionized calcium level by decreasing protein binding

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3
Q

What effect do alkalotic states have on ionized calcium level?

A

Decrease ionized calcium level by increasing protein binding

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4
Q

What are the main factors controlling plasma calcium level?

A

PT
Vit D
Calcitonin

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5
Q

Where is PTH produced?

A

Chief cells in parathyroid glands

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6
Q

When is PTH secreted?

A

Low plasma calcium
Low Vit D
High phosphate

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7
Q

What are the effects of PTH?

A

Raises plasma calcium
-stimulates cal reabsorption from bone
-increases renal tubular cal reabsorption
-stimulates increased GI cal absorption (indirect)
Increases renal phosphate excretion

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8
Q

Where is Vitamin D produced?

A

Synthesised in skin (D3 cholecalciferol)

Ingested (D2 ergocalciferol) –> hydroxylated in liver to 25-OH-D2/3 –> hydroxylated in kidney to active Vit D

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9
Q

What are the effects of Vitamin D?

A

Increases absorption of calcium & phosphate from GI tract
Increases renal re-absorption of Ca
Required for normal bone formation

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10
Q

What are the causes of Vitamin D deficiency?

A

Inadequate sunlight exposure (rickets)
Malabsorptive condition
Liver/kidney disease

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11
Q

Where is Calcitonin produced?

A

Parafollicular C cells of thyroid gland

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12
Q

When is Calcitonin secreted?

A

Increased plasma calcium

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13
Q

What are the effects of Calcitonin?

A

Decreases plasma calcium by antagonising the effect of PTH on bone

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14
Q

What determines intestinal uptake of calcium?

A

Ionized calcium levels in lumen

Presence of activated Vit D

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15
Q

What determines renal excretion of calcium?

A

Na reabsorption in proximal tubule (90%)
PTH regulation in distal tubule (10%)
Vit D in PCT

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16
Q

What is hypercalcaemia?

A

Plasma calcium

>2.5mmol/L

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17
Q

What is the most common cause of hypercalcaemia?

A

1o hyperparathyroidism/malignancy (97%)

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18
Q

What are the causes of excessive PTH secretion, leading to hypercalcaemia?

A

1o hyperparathyroidism
3o hyperparathyroidism
Ectopic PTH secretion (v. rare)

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19
Q

What are the malignant causes of hypercalcaemia?

A

Myeloma
Metastatic deposits in bone
Paraneoplastic (SCC)

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20
Q

What are the causes of excess Vit D, leading to hypercalcaemia?

A

Exogenous excess
Granulomatous disease (TB, sarcoid)
Lymphoma

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21
Q

What are the causes of excess calcium, leading to hypercalcaemia?

A

Milk-alkali syndrome

-antacids increase absorption of calcium

22
Q

What are the other endocrine causes of hypercalcaemia?

A

Thyrotoxicosis

Addison’s

23
Q

What are the renal causes of hypercalcaemia?

A

Severe AKI

24
Q

What are the iatrogenic causes of hypercalcaemia?

A

Thiazide diuretics

Lithium

25
What are the hereditary causes of hypercalcaemia?
Familial hypocalciuric hypercalcaemia
26
What is the cause of 1o hyperparathyroidism?
Single parathyroid adenomas (80%) | Diffuse glandular hyperplasia (20%) - MEN IIa/IIb
27
How can PTH levels distinguish b/w hyperparathyroidism & malignancy?
High in hyperparathyroidism | Low in malignancy
28
What are the PTH/calcium levels like in 1o hyperparathyroidism?
PTH high | Calcium high
29
How is 1o hyperparathyroidism managed?
Parathyroidectomy
30
What is the major complication of parathyroidectomy?
Post-op hypocalcaemia | Give adcal for 14/7
31
What is 2o hyperparathyroidism?
Physiological hypertrophy of all parathyroid glands, in response to hypocalcaemia
32
In which pts is 2o hyperparathyroidism seen?
Renal disease | Vit D deficiency
33
What are the PTH/calcium levels like in 2o hyperparathyroidism?
PTH high | Calcium low/normal
34
What is the cause of 3o hyperparathyroidism?
Long-standing 2o hyperparathyroidism | Occurs mostly in renal failure
35
What are the PTH/calcium levels like in 3o hyperparathyroidism?
PTH high Calcium high Phosphate grossly high
36
What is the management of 2o hyperparathyroidism?
Address cause of hypocalcaemia
37
What is the management of 3o hyperparathyroidism?
Parathyroidectomy
38
How does 1o hyperparathyroidism present?
Often asymptomatic | Sx related to hypercalcaemia
39
What are the sx of hypercalcaemia?
Bones - bone pain, fractures, muscle weakness Stones - renal stones, polyuria, AKI/CKD Groans - abdo pain, vom, const, pancreatitis, GI ulcers Moans - depression, confusion, tiredness, hypotonicity
40
What investigations are appropriate in suspected 1o hyperparathyroidism?
``` PTH (raised) Ca (raised) PO4 (low) ALP (raised) 24hr urinary calcium (raised) DXA scan (assess osteoporosis) Technetium/USS (localise tumour) ```
41
How can 1o hyperparathyroidism be distinguished from familial hypocalciuric hypercalcaemia?
In FHH low 24hr urinary calcium | Can use spot calcium:creatinine excretion
42
How can 1o hyperparathyroidism be distinguished from 3o hyperparathyroidism?
``` Clinical presentation PO4 levels (low/normal in 1o) ```
43
What syndromes is 1o hyperparathyroidism associated with?
Multiple Endocrine Neoplasia | -autosomal dominant
44
What tumours does MEN I produce?
Parathyroid hyperplasia/adenoma Pancreatic endocrine tumours (gastrinoma/insulinoma) Pituitary adenoma
45
What tumours does MEN IIa produce?
Thyroid medullary carcinoma Adrenal PCC Parathyroid hyperplasia
46
What tumours does MEN IIb produce?
MEN IIa Mucosal neuromas Marfanoid appearance No hyper PTH
47
What is the immediate management of a patient presenting w/ acute hypercalcaemia?
If Ca >3.5mmol/L AND sev sx - IV fluids (0.9% NaCl, 3-6L/24hrs, diuretics if overloaded) - Bisphosphonates (pamidronate, lowers Ca over 2-3/7) - Calcitonin (rapidly reduce Ca, short-lived) - Dialysis (if renal impairment)
48
What is the non-immediate management of a patient presenting w/ acute hypercalcaemia?
Investigate/treat cause of hypercalcaemia
49
When are steroids used in hypercalcaemia?
If hypercalcaemia due to myeloma, lymphoma or sarcoid
50
What is the potentially life threatening complication of 1o hyperparathyroidism?
Reduced QT interval | Can lead to cardiac arrest

CP3 @ UoN - Medicine & Surgery (135 decks)

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