Hypercalcemia Flashcards
The vast majority of Calcium is in the ____________ while the least is in the ____________
Most: bone (99%)
Least: serum (<0.2%)
Calcium has what roles in the body
Structural integrity of skeleton
Neuro-muscular excitability
Blood coagulation
Hormonal secretion
Hypercalcemia (increases/decreases) the depolarization threshold resulting in (increased/decreased) neuro-muscular excitability
Increases threshold; decreases excitability
- Hypercalcemia decreases Na permeability
Hypocalcemia (increases/decreases) the depolarization threshold resulting in (increased/decreased) neuro-muscular excitability
Decreases threshold; increased excitability
- Hypocalcemia increases Na permeability
Drug that functions at the level of the Calcium Sensing Receptor on Parathyroids to DECREASE PTH release; used for either Primary or Secondary Hyperparathyroidism
Cinacalcet
Signs/Symptoms of HYPERcalcemia
“Stones, bones, groans, and psychiatric overtones”
- Stones (kidney stones)
- Bones (pain and fractures)
- Groans (abd pain, nausea, vomiting, anorexia, constipation, pancreatitis)
- Psychiatric Overtones (lethargy, depression, anxiety, psychosis, etc.)
- Hypotonia
- Hypertension
- Short QT
- Polyuria/dehydration
Besides Stones, Bones, Groans and Psychiatric Overtones, what other symptoms of HYPERcalcemia can you have?
Hypotonia (inc. depolarization threshold)
Hypertension
Short QT
Polyuria/dehydration
What can cause Hypercalcemia
- PRIMARY Hyperparathyroidism
- Vitamin D excess
- Sarcoidosis
- Squamous cell cancer (PTH-PR secreting)
- Multiple Myeloma
- Lithium
- Thiazide diuretics
- Milk-alkali syndrome
How to diagnose Hypercalcemia
Measure serum/urine calcium
Measure PTH
Measure Vitamin D
MOST common cause of Hyperparathyroidism in the OUTPATIENT setting
Primary Hyperparathyroidism
MOST common cause of Hyperparathyroidism in the Outpatient setting; high PTH, high Ca, low Phosphorus; can result in kidney stones and Osteitis Fibrosa Cystica; usually due to an Parathyroid Adenoma; treat with surgery and Cinacalcet
Primary Hyperparathyroidism
Primary Hyperparathyroidism is usually caused by…
Parathyroid Adenomas
Treatment for Primary Hyperparathyroidism
Surgery
Cinacalcet
Most common cause of TERTIARY Hyperparathyroidism
Chronic Kidney Disease (or transplant)
Type of Hyperparathyroidism; can be causes by Chronic Kidney Disease; due to low Vitamin D activation, resulting in low Calcium triggering high PTH and eventually long-term autonomous overproduction (adenoma-like process)
Tertiary Hyperparathyroidism
Types of Familial Hyperparathyroidism
FHH (inactivating mutation of CaSR)
HPTH-Jaw Tumor Syndrome (mutation of HRPT2)
MEN 1 (mutation of MEN1 tumor suppressor)
MEN 2a (mutation of RET)
Familial Hypocalcuric Hypercalcemia (FHH) is caused by a mutation of ________, preventing kidney and parathyroid gland from sensing calcium, leading to _______ and __________
CaSR
hypocalciuria (dec. ca+2 excretion)
hypercalcemia (inc. serum ca+2)
HPTH-Jaw Tumor Syndrome is a type of familial hyperparathyroidism caused by a mutation of ____________
HRPT2 tumor suppressor
MEN 1 is a type of familial hyperparathyroidism caused by a mutation of…
MEN 1 tumor suppressor
MEN 2a is a type of familial hyperparathyroidism caused by a mutation of…
RET proto-oncogene (encodes tyrosine kinase receptor)
When should you suspect a Familial Hyperparathyroidism
Symptoms with a history of parathyroidectomy
What are the 3 “P’s” of MEN 1
HyperParathyroidism
Pituitary tumors
Pancreatic tumors
What is “MPH” for MEN 2a
Medullary thyroid cancer
Pheochromocytoma
Hyperparathyroidism
Hyperparathyroidism due to a mutation causing a constitutively active G protein (GNAS gene); characterized “jagged coast of Maine” cafe au lait lesions that does NOT cross the midline, precocious puberty, hypercalcemia, and high alk phos (bone turnover)
McCune Albright Syndrome
