Hypercalcemia

Question 1

What is the adjusted calcium calculation

Answer 1

total serum ca + 0.02(40-albumin)

Question 2

Causes of PTH mediated hyperCa (high or abnormally normal PTH)

Answer 2

Primary HyperPTH, secondary, tertiary, FHH, lithium

Question 3

Causes of non-PTH mediated hyperCa (low PTH)

Answer 3

Malignancy (PTHrp, osteolytic, increased calcitriol), Granulomatous, Endocrine (thyroid, adrenal insufficiency, pheo) and Medications (milk alkali syndrome - antacids , thiazide, lithium, vitamin D excess)

Question 4

Treatment of HyperCa

Answer 4

Treatment
- Volume expansion + nutriuresis
- Loop diuretics once euvolemic
- Bisphosphonates
o Inhibition of osteoclast activity, Zoledronate morepotent than pamidronate and less SE
- Calcitonin
o Additive effect with bisphosphonates, Inhibits osteoclastic bone resorption, promotes excretion of calcium
- Corticosteroids
o Decrease GI absorption by decreasing calcitriol production (hypervitaminosis and sarcoidosis)
o Anti tumor effects
- Others: Gallium nitrate, PTHrH antibodies

Question 5

Causes of stridor after parathyroidectomy

Answer 5

• RLN injury
• Neck Hematoma
• Laryngeal spasm from hypocalcemia

Question 6

What is the mx of hypocalcemia

Answer 6

• IV calcium gluconate (fast then as a infusion)
• Correct electrolyte imbalances (esp low Mg levels)
• Mx to be started on Calcium Carbonate and Rocaltrol