Hypercalcemia Flashcards
Define hypercalcemia
increase in serum calcium
what are the two main causes of hypercalcemia?
- primary parathyroidism ➔ think more of a healthy pt
- malignancy associated hypercalcemia ➔ think more sick pt in hospital
what are some (4) PTH dependant causes of hypercalcemia?
- primary parathyroidism ➔ parathyroid adenoma or MEN1
- tertiary parathryoidism ➔ hyperplasia parathyroid
- familial hypocalcuric hypercalcemia
- drugs: lithium
what are some (4/6) PTH independant causes of hypercalcemia?
- milk-alkali syndrome
- hypervitaminosis D
- ectopic tumour (malignancy/lytic bone lesions) - secreting PTHrP
- granulomatous disease (TB, sarcoidosis) or lymphomas
- Drugs: thiazide diuretics
- Endocrine: hyperthyroidism, acromegaly, adrenal insufficiency
can hypercalcemic pts be asymptomatic?
yes
what do hypercalcemic crisis pts look like?
- constitutional s/s
- mental status changes (profound lethargy and coma)
- arrythmias/cardiovascular issues
Medical emergency!
what are s/s of hypercalcemia?
- Groans: GI s/s like N/V, abdo pain ➔ PUD and pancreatitis
- Moans: fatigue and malaise
- Bones: bone pain ➔ osteoporosis, arthritis, frequent fractures, osteitis fibrosa cystica (brown tumour)
- Stones: renal stones
- Thrones: polyuria and constipation
- Psychiatric Overtones: lethargy, confusion, memory loss
Other
- cardio: arrythmias and HTN
- muscle weakness/twitches
What Ix would you order to workup non crisis hypercalcemia?
confirm if true hypercalcemia
1. repeat the serum calcium + add albumin to be able to correct OR would order an ionized calcium
2. PTH levels
3. 24 hour urine calcium
determine etiology
- PTHrP ➔ suspected maliganancy
- nuclear medicine parathyroid scan ➔ primary parathyroidism
- CXR ➔ granulomatosis disease
- 25-hydroxyvitamin D level ➔ vitamin D toxicity
- 1, 25- hydroxyvitamin D levels ➔ vitamin D toxicity (activated vitamin D)
- ALP ➔ sole elevation leads to thinking bone issue/cancer
at what level of serum calcium, would we expect the pt start showing s/s and need urgent treatment?
> 3 mmol/L
at what serum calcium level would be expected if pt starts having coma and DLOC s/s?
> 3.25 mmol/L
what ix would you order for a severe hypercalcemic pt with coma s/s?
- CBC - hct/hg
- electrolytes
- extended lytes - to include calcium
- ecg
- VBG
- glucose
- creatinine and urea
what tx options are available for hypercalcemia?
- calcitonin
- bisphosphonates
- denosumab (prolia)
- resection of tumour
- corticosteroids ➔ granulomatous diseases
- hydration ➔ to encourage urinary excretion of calcium
- could consider loop diuretics if adequately hydrated
