Hypercalcemia Flashcards

1
Q

Diagnostic algorithm

A
  1. Acute
    a. PTH high
    - >Primary hyperparathyroidism
    b. PTH low
    - >Consider malignancy, PTHrP, clinical evaluation
  2. Chronic
    a. PTH low
    - >Granulomatous disease
    - >Familial hypercalciuric hypercalcemia
    - >Milk-alkali syndrome
    - >Medications: lithium, thiazides
    - >Immobilisation
    - >Vit D or Vit D intoxication
    - >Adrenal insufficiency
    - >Hyperthyroidism
    b. PTH high
    - >Primary, secondary, tertiary
    - >Consider MEN syndrome
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2
Q

Primary hyperPTH: mechanism, clinical presentation, diagnostic criteria, treatment

A

Elevated PTH= +bone turnover
Solitary adenoma or part of MEN->nephrolithiasis, vomiting, abdominal pain, polydipsia, polyuria, depression, fatigue “stones, bone, and abdominal groans and psychic moans”

+Calcium, +PTH, low phosphate

Medical therapy for symptoms
Surgery for symptoms of hypercalciuria or osteoporosis

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3
Q

How does lithium cause hypercalcium

A

Stimulates PTH production

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4
Q

Malignancy-related: mechanism, clinical presentation, diagnostic criteria, treatment

A

Local destruction of bone
Production of PTHrP

Symptoms of hypercalcemia and of particular cancer

Imaging of bones, PTHrP levels, bone marrow biopsy

Treat tumor and control cancer
Bisphosphonates
Calcitriol

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5
Q

Sarcoidosis: mechanism, clinical presentation, diagnostic criteria, treatment

A

++Vitamin D synthesised in macrophages and lymphocytes
Low PTH elevated Vitamin D

Avoid sunlight, decrease vitamin D and calcium intake
Glucocorticoids if needed

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6
Q

Renal insufficiency: mechanism, clinical presentation, diagnostic criteria, treatment

A

Secondary as a result of partial resistance to PTH effectes
Bone pain, pruritis, ectopic calcification, osteomalacia
+Renal function
Limited dietary phosphate IV calcitriol

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7
Q

Overview management of hypercalcemia acute

A
  1. Hydration + loop diuretics
  2. Bisphosphonate
  3. Calcitonin->while awaiting effect of bisphosphonate
  4. Glucocorticoids (effective in cancer-induced, calcitriol mediated)
  5. Avoid exacerbating medication
  6. Dialysis
  7. Treat underlying malignancy
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8
Q

Corrected calcium

A

Add 0.8 mg/dL to the serum total calcium

for every 1 g/dL of albumin level below 4 g/dL

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9
Q

Most common etiology (2)

A
  1. Primary hyperparathyroidism
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10
Q

Clinical features

A

GIT: abdominal pain, peptic ulcer, vomiting, constipation
Kidney: polyuria, polydipsia, stones
CNS: psychosis, fatigue, depression
Bones: bone pain

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11
Q

Investigations

A
Total serum calcium
Serum ionised calcium
Serum albumin
CMP, UEC, glucose
Resting ECG->decreased QT
Serum PTH
PTHrP
Serum phosphorus
Calcitriol
25-hydroxyvitamin D
Consider:
Skeletal survey
CXR
Serum electrophoresis
24 hour urinary calcium excretion
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12
Q

How does magnesium relate to calcium

A

Decreased magnesium inhibits PTH->hypocalcemia

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13
Q

MEN 1 malignancy

A

Parathyroid hyperplasia/adenoma
Pancreas endocrine->gastrinoma, insulinoma etc
Pituitary prolactinoma

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14
Q

MEN 2 a

A

Thyroid->meduallry
Adrenal phaeochromocytoma
Parathyroid hyperplasia

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15
Q

MEN 2b

A

Similar to MEN 2a, + mucosal neuromas and marfinoid appearance, no +PTH

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