Hypercalcemia

Question 1

What is the classic presentation of hypercalcemia?

Answer 1

Bones (fractures), stones (kidney stones), abdominal groans (abd pain, constipation), and psychiatric moans (AMS).

Question 2

What is the definition of hypercalcemia?

Answer 2

Ca2+ > 10.2

Question 3

Under what circumstances should calcitonin be given for hypercalinemia?

Answer 3

only very very elevated and symptomatic

Question 4

What is the treatment for hypercalcinemia?

Answer 4

IVF IVF IVF IVF + bisphosphonates if severe

Question 5

If you are using a diuretic for hypercalcinemia, which kind? What must you do first?

Answer 5

Loop diuretic.

Thiazides increase tubular reabsorption of Ca2+.

Question 6

What are the two most common causes of hypercalcemia?

Answer 6

Hyperparathyroidism and malignancy.

Question 7

What is primary hyperparathyroidism? What will labs show?

Answer 7

Autonomous secretion of PTH from adenoma (usually benign). PTH up, Ca2+ up, phos down.

Question 8

What is secondary hyperparathyroidism?

Answer 8

Early renal failure. Elevated PTH is the appropriate response to relative hypoCa.

Question 9

What is tertiary hyperparathyroidism?

Answer 9

Following persistent stimulation of secondary hyperparathyroidism, multiple adenomas develop and begin to secrete PTH.

Question 10

How to distinguish primary, secondary, tertiary hyperparathyroidism?

Answer 10

Sestamibi scan.

Question 11

Treatment of hyperparathyroidism?

Answer 11

Resection. Watch out for hypoparathyroidism!

Question 12

What’s one way to reduce parathryoid action?

Answer 12

Cinnacalcet - calci-mimetic.

Question 13

What are the two ways malignancy causes hypercalcemia?

Answer 13

1. Metastases

2. SCC of the lung

Question 14

How do mets cause hypercalcemia? What will labs look like?

Answer 14

Invade bone. Release of Calcium, Phos, low PTH.

Question 15

How does SCC of the lung cause hypercalcemia?

Answer 15

PTHrP mimics PTH. Increased Ca2+, DECREASED phos (kidney getting stimulated), decreased PTH. Elevated PTHrP.

Question 16

What is one cause of hypervitaminosis D?

Answer 16

Granulomatous disease (sarcoid, TB).

Question 17

How does granulomatous disease cause hypercalcemia? What other lab findings?

Answer 17

Increases levels of activated vitamin D, which increases absorption of calcium. Decreased PTH, increased phos (kidney excreting less since PTH is low). High 1-25 Vitamin D level.

Question 18

What is a familial syndrome that may cause hypercalcemia?

Answer 18

Familial hypercalcemic hyPOcaliuria. No peeing enough calcium. The PTH will be slightly up. Urine ca will be low.

Question 19

What other things cause hypercalcemia?

Answer 19

Immobilization. Paget’s. Addison’s. Acromegaly. Thiazides. Milk-alkali syndrome.