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Endocrinology - year 2 > hypercalcemia > Flashcards

hypercalcemia Flashcards

1
Q

initiate emergency management of hypercalcemia

  • diagnose cause before imaging
  • contrast pth-dep and pth-indep causes
  • apply guidleines when referring for parathyroid Sx
  • apply basic physiology of calcium and vitamin D metabl in management of post op hypocalcemia
A

.

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2
Q

Symptoms/signs of hypercalcemia

A

Bones - osteoporosis
Stones - Nephrolithiasis, polyuria
Groans - GI/abdo pain
Psychic overtones - neuropsych

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3
Q

Initial management of hypercalcemia is

A

FLUIDS

  1. Isotonic saline 300-500ml/Hr
  2. Saline + Loop Diuretic
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4
Q

How much Lasix do you need to add in state of hypercalcemia?

A

20-40 mg IV to treat volume overload

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5
Q

what is the physiologically active kind of calcium?

A
  • ionized calcium
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6
Q

In a hypoalbumin state -

A

total calcium might be lower but ionized calcium might be ok

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7
Q

Correcting for low albumin states

A
  • Every 10 mmol/L decrease in albumin increase total calcium by 0.2
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8
Q

Why is creatinine high in hypercalcemia?

A
  • acute renal failure –> hypovolemia
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9
Q

To diagnose hypercalcemia always order

A

PTH

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10
Q

3 ways in which PTH acts

A

1 - bone resorption
2- increase hydroxylation of vitamin D in kidney
3- Renal Ca+2 resorption

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11
Q

which enzyme does PTH activate?

A

alpha-hydroxylase in the kidney

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12
Q

2 PTH-dependent causes of hypercalcemia

A

1- Primary hyperparathyroidism

2- Familial hypercalcemic hypocalciuria

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13
Q

PTH independent causes of hypercalcemia-

A
  • Malignancy
  • Drugs
  • increased intake
  • Granulomatous disease
  • Pheo/thyrotox/addison’s
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14
Q

What type of drugs can cause hypercalcemia

A
  • Thiazide diuretics
  • Lithium
  • Theophyline
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15
Q

Most common cause of hypercalcemia of malignancy

A
  • Humoral - Paraneoplastic- (80%)
  • Osteolytic (20%)
  • 1,25 Vit D (<1%)
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16
Q

Causes of humoral/paraneoplastic PTH/PTHrP secretion

A
  • Squamous cell cancer
  • Renal cancer
  • Ovarian cancer
17
Q

Causes of osteolytic mets hypercalcemia

A
  • Breast cancer
  • MM
  • Lymphoma
18
Q

In PTH-dependent hypercalcemia why is phosphate low?

A
  • PTH has an effect on kidneys - promotes renal excretion of phosphate
19
Q

Treatment of hypercalcemia - 4 things to keep in mind!

A

1- volume expand
2- bisphosphonates - IV
3- gluc - in granulomatous disease prednisone
4- calcitonin- not useful

20
Q

How do bisphosphonates work in context of hypercalcemia

A
  • inhibit release of calcium from bone
  • MUST be IV
  • Pamidrone/zoledronic acid
21
Q

When are glucorticoids useful for treating hypercalcemia?

A
  • PTH-independent extra renal production of calcitriol -
  • lymphoma
  • sarcoidosis
  • TB
22
Q

Extra renal production of calcitriol can occur where?

A
  • Lymphoma
  • Sarcoidosis
  • TB
  • alpha hydroxylase active
23
Q

3 things to keep in mind for emergency treatment of hypercalcemia

A

1) Fluids
2) Furosemide - loop diuretuc
DELAYED: bispho and gluc

24
Q

Common causes of secondary Hyperparathyroidism (calcium is low, pth HIGH)

A
  • Renal failure
  • vit D deficiency
  • Malabsorption- celiac
  • PTH resistance
  • hyperphosphatemia
25
Q

Most common cause of PRIMARY hyperparathyroidism

A
  • ADENOMA
26
Q

4 INDICATIONS for Surgery

A

1) ALL symptomatic with hypercalcemia
2) Asymptomatic
- - Serum calcium > 0.25
- - Creatinine clearance < 60ml/min
- - Bone density T-score < 2.5
- - Age < 50

27
Q

Sign of hypocalcemia post surgery

A

Chovstek sign

Troussea’s sign

28
Q

Hypocalcemia can be a precursor to what EKG abnormality

A

Torsades de pointe

29
Q

Mild vs severe treatment of post-op hypocalcemia

A

Mild - oral calcium
Severe - IV calcium
Activated Vitamin D - 1,25 Vit D
HAVE TO GIVE CALCITRIOL

30
Q

When do you have to give active calcitriol? in stead of OTC Vit D?

A
  • If in renal failure

- post op hypocalcemia - PTH is too low

31
Q

MEN1 mutations can cause 3 Ps

A

Primary Hyperparathyroidism

  • Pituitary tumors (10-20%)
  • Enterohepatic tumors (gastrinoma, insulinoma)

Endocrinology - year 2 (10 decks)

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