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Endocrine-Week 1/2 > Hypercalcemia > Flashcards

Hypercalcemia Flashcards

1
Q

The vast majority of Calcium is in the ____________ while the least is in the ____________

A

Most: bone (99%)
Least: serum (<0.2%)

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2
Q

Calcium has what roles in the body

A

Structural integrity of skeleton
Neuro-muscular excitability
Blood coagulation
Hormonal secretion

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3
Q

Hypercalcemia (increases/decreases) the depolarization threshold resulting in (increased/decreased) neuro-muscular excitability

A

Increases threshold; decreases excitability

  • Hypercalcemia decreases Na permeability
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4
Q

Hypocalcemia (increases/decreases) the depolarization threshold resulting in (increased/decreased) neuro-muscular excitability

A

Decreases threshold; increased excitability

  • Hypocalcemia increases Na permeability
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5
Q

Drug that functions at the level of the Calcium Sensing Receptor on Parathyroids to DECREASE PTH release; used for either Primary or Secondary Hyperparathyroidism

A

Cinacalcet

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6
Q

Signs/Symptoms of HYPERcalcemia

A

“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
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7
Q

Besides Stones, Bones, Groans and Psychiatric Overtones, what other symptoms of HYPERcalcemia can you have?

A

Hypotonia (inc. depolarization threshold)
Hypertension
Short QT
Polyuria/dehydration

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8
Q

What can cause Hypercalcemia

A
  • PRIMARY Hyperparathyroidism
  • Vitamin D excess
  • Sarcoidosis
  • Squamous cell cancer (PTH-PR secreting)
  • Multiple Myeloma
  • Lithium
  • Thiazide diuretics
  • Milk-alkali syndrome
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9
Q

How to diagnose Hypercalcemia

A

Measure serum/urine calcium
Measure PTH
Measure Vitamin D

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10
Q

MOST common cause of Hyperparathyroidism in the OUTPATIENT setting

A

Primary Hyperparathyroidism

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11
Q

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

A

Primary Hyperparathyroidism

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12
Q

Primary Hyperparathyroidism is usually caused by…

A

Parathyroid Adenomas

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13
Q

Treatment for Primary Hyperparathyroidism

A

Surgery

Cinacalcet

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14
Q

Most common cause of TERTIARY Hyperparathyroidism

A

Chronic Kidney Disease (or transplant)

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15
Q

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)

A

Tertiary Hyperparathyroidism

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16
Q

Types of Familial Hyperparathyroidism

A

FHH (inactivating mutation of CaSR)
HPTH-Jaw Tumor Syndrome (mutation of HRPT2)
MEN 1 (mutation of MEN1 tumor suppressor)
MEN 2a (mutation of RET)

17
Q

Familial Hypocalcuric Hypercalcemia (FHH) is caused by a mutation of ________, preventing kidney and parathyroid gland from sensing calcium, leading to _______ and __________

A

CaSR
hypocalciuria (dec. ca+2 excretion)
hypercalcemia (inc. serum ca+2)

18
Q

HPTH-Jaw Tumor Syndrome is a type of familial hyperparathyroidism caused by a mutation of ____________

A

HRPT2 tumor suppressor

19
Q

MEN 1 is a type of familial hyperparathyroidism caused by a mutation of…

A

MEN 1 tumor suppressor

20
Q

MEN 2a is a type of familial hyperparathyroidism caused by a mutation of…

A

RET proto-oncogene (encodes tyrosine kinase receptor)

21
Q

When should you suspect a Familial Hyperparathyroidism

A

Symptoms with a history of parathyroidectomy

22
Q

What are the 3 “P’s” of MEN 1

A

HyperParathyroidism
Pituitary tumors
Pancreatic tumors

23
Q

What is “MPH” for MEN 2a

A

Medullary thyroid cancer
Pheochromocytoma
Hyperparathyroidism

24
Q

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)

A

McCune Albright Syndrome

25
Q

What are some endocrine causes of MILD Hypercalcemia

A

Hyperthyroidism
Adrenal Insufficiency*
Pheochromocytoma*
VIPoma *

*due to volume contraction

26
Q

What drugs/supplements can cause Hypercalcemia

A
  1. Vitamine D overdose
  2. Milk-Alkali syndrome
    - old tx of peptic ulcer
  3. Lithium
    - dec. renal clearance of Ca+2
  4. Thiazide diuretics
    - Potentiate PTH at receptor
27
Q

A condition characterized by hilar lymphadenopathy and infiltrates on x-ray; cause non-caseating granulomas and hypercalcemia (1,25-OH2-D from macrophages)

A

Sarcoidosis

Endocrine-Week 1/2 (18 decks)

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