Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y3M - Diabetes & Endocrinology > Hypo & Hypercalcaemia > Flashcards

Hypo & Hypercalcaemia Flashcards

1
Q

What range of calcium suggests hypercalcaemia?

A

Serum > 2.6 mmol/l

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Commonest causes of hypercalcaemia.

A

Primary hyperparathyroidism

Malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can one distinguish between primary hyperparathyroidism and malignancy?

A

Primary hyperparathyroidism is associated with normal or high PTH

Malignancy will be associated with a low PTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is hypercalcaemia with suppressed PTH until proven otherwise?

A

Malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which malignancy is usually the cause of hypercalcaemia?

A

Squamous cell epithelial tumours of the lung due to the secretion of PTH-rP

However rarely lymphoma can also cause hypercalcaemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

In what stages of malignancy does hypercalcaemia usually present?

A

In large or advanced tumours.

Bony metastases are not always present.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When other than in malignancy might hypercalcaemia with a low PTH present?

A

Benign granulomatous disease such as TB or sarcoidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is hypercalcaemia with non-suppressed PTH until proven otherwise?

A

Primary hyperparathyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is primary hyperPTH usually caused by?

A

A single parathyroid adenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does parathyroid hyperplasia in more than one gland suggest?

A

Genetic cause such as multiple endocrine neoplasia.

It can also be present in CKD due to secondary hyperPTH, however calcium levels will be low in this case.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What might a very high serum calcium > 3.5 mmol/l with a large parathyroid tumour indicate?

A

Parathyroid cancer.

This is very rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What might parathyroid cancer rarely occur in association with?

A

Jaw tumours

This is called Hyperparathyroidism-jaw tumour syndrome.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Most common clinical presentation of primary hyperPTH.

A

Often asymptomatic and discovered incidentally during routine blood tests.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Give examples of non-specific symptoms of hypercalcaemia.

A

Tiredness

Generalised aches and pains.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Specific symptoms of hypercalcaemia.

A

Polyuria

Polydipsia

Nephrogenic DI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Other symptoms of hypercalcaemia.

A

Abdominal pain

Constipation

Psychiatric symptoms

Kidney stones

Remember Bones, Groans, Stones and Moans.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What can severe metabolic parathyroid bone disease cause?

A

Classical cystic appearance on X-ray.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the classical cystic appearance on X-ray associated with severe metabolic parathyroid bone disease?

A

Brown Tumours

Osteitis fibrosa cystica

Subperiosteal erosions

Cysts

Acro-osteolysis

Pepper-pot skull

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Investigations of primary hyperPTH.

A

Bloods

Imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Blood findings in primary hyperPTH.

A

High or non-suppressed PTH

Hypercalcaemia

Low phosphate

High ALP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why might ALP be high in primary hyperPTH?

A

Co-exisiting vitamin D deficiency can lead to increased bone turnover.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Imaging findings of primary hyperPTH.

A

X-ray showing reduced bone density, sub-periosteal erosion of the phalanges.

Renal ultrasound can show nephrocalcinosis.

You might get chondrocalcinosis in joints that looks like pseudogout.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is nephrocalcinosis?

A

Calcium depositions in the kidneys.

Associated with nephrolithiasis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is familial hypocalciuric hypercalcaemia (FHH)?

A

A genetic defect in the calcium sensing receptor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

FHH and primary hyperPTH can show similar levels of PTH and calcium.

How can the two be distinguished?

A

FHH shows a low urine calcium/creatinine ratio

Usually a family history of mild hypercalcaemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Why is it important to exclude FHH?

A

So you don’t send the patient to have an unnecessary neck exploration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

If it is deemed necessary to do parathyroid surgery, what is important to do?

A

Localise the adenoma.

28
Q

How is a parathyroid adenoma localised?

A

Experienced hands might be able to do it by parathyroid ultrasound. It is however very operator-dependent.

SETAMIBI isotope scanning alongside of ultrasound is commonly performed.

SPECT CT / MRI and 4-D CT can also be used.

29
Q

When should surgery be performed in hyperparathyroidism?

A

Surgery should be considered if serum calcium > 2.85 mmol/l or if symptoms are severe.

Young patients and severe acute hypercalcaemia.

30
Q

What treatment can be considered if the patient is ineligible for surgery?

A

Drugs such as calcimimetics which are effective at lowering calcium in primary hyperPTH.

31
Q

What are the dangers of acute severe hypercalcaemia?

A

Medical emergency characterised by profound dehydration and renal impairment.

32
Q

Treatment of acute severe hypercalcaemia.

A

First off stabilise hydration by giving IV saline.

Give IV bisphosponates such as zoledronic acid to counter the calcium levels.

When everything is stabilised you can consider glucocorticoids, calcitonin, calcimimetics or parathyroidectomy.

33
Q

When might glucocorticoids be given in hypercalcaemia?

A

In lymphoma or granulomatous disease.

34
Q

When does symptomatics hypocalcaemia occur?

A

When serum calcium is < 1.9 mmol/l or at higher values if there is a rapid drop in calcium.

35
Q

Most common cause of hypocalcaemia.

A

Post-surgical hypoPTH following thyroidectomy.

36
Q

Prognosis of post-surgical hypoparathyroidism.

A

Often temporary, usually there is recovery of the parathyroid.

However it can be permanent if there is damage or inadvertent removal of the parathyroid.

This means that long-term follow-up is needed to assess if there is recovery of the parathyroid.

37
Q

What else can cause hypocalcaemia?

A

Vitamin D deficiency

Hypomagnesaemia

38
Q

In which populations should vitamin D deficiency be considered?

A

High risk groups such neonates and elderly.

Northern africans

Populations which commonly covers themselves in clothes entirely.

39
Q

Presentation of vitamin D deficiency in neonates.

A

Seizures

Tetany

This is due to hypocalcaemia.

40
Q

How can you distinguish via bloods between hypoparathyroidism and vitamin D defiency?

A

Phosphate will be low in vitamin D deficiency due to elevated PTH levels.

In hypoparathyroidism phosphate will be high due to low PTH levels.

41
Q

What does hypomagnesaemia cause?

A

Functional hypoparathyroidism with normal or low PTH levels due to inhibition of the parathyroid.

42
Q

Common causes of hypomagnesaemia.

A

GI loss

Alcohol

Drugs such as PPis.

43
Q

Clinical features of acute severe hypocalcaemia.

A

Laryngospasm

Prolonged QT interval

Seizures

44
Q

How does hypocalcaemia usually present?

A

Muscle cramps

Carbo-pedal spasms

Peri-oral and peripheral paraesthesia

Neuro-psychiatric symptoms

45
Q

Tests to assess hypocalcaemia.

A

Positive Chvosteks sign

Positive Trousseaus sign

46
Q

Explain a +ve Cvhosteks sign.

A

Facial spasm when the cheek is gently tapped with a finger.

47
Q

Explain a +ve Trousseaus sign.

A

Carpo-pedal spasms induced by the inflation of a sphygmomanometer (blood-pressure cuff)

48
Q

Treatment of acute hypocalcaemia.

A

IV calcium

49
Q

Treatment of severe vitamin D deficiency.

A

Loading dose of cholecalciferol

20000 IU per week given for 7 weeks.

Then a maintenance dose of 1-2000 IU per week.

50
Q

Treatment of hypoparathyroidism.

A

1-alfacalcidol or calcitriol

Sandocal or Adcal D3 (oral calcium supplements) are given in combination with 1-alfacalcidol.

51
Q

Dose regiment of 1-alfacalcidol in hypoparathyroidism.

A

Starting dose of 0.25 microgram/day

52
Q

Aim of treatment of hypocalcaemia.

A

Symptom relief

Keep calcium levels at lower end of reference range.

53
Q

Why is the treatment aim to keep the calcium levels at the lower reference range?

A

To reduce the risk of nephrocalcinosis.

54
Q

Treatment of acute magnesium deficiency.

A

Any drugs that caused it should be stopped.

IV magnesium replacement started.

Usually given as MgS04 24 mmol/24 hours.

55
Q

Treatment of magnesium deficiency if there is chronic GI loss or alcohol ingestion?

A

Appropriate specialist input.

56
Q

What is pseudo-hypoparathyroidism?

A

A rare condition caused by a mutation in a G protein coupled to the PTH receptor leading to PTH resistance.

57
Q

Parathyroid hallmarks of pseudo-hypoparathyroidism.

A

Hypocalcaemia

High phosphate

High PTH

Normal vitamin D

58
Q

How can you distinguish between pseudo-hypoparathyroidism and hypoparathyroidism?

A

Low levels of calcium and high levels of phosphate usually suggest hypoparathyroidism. This is because of low levels of PTH.

Howevery the high levels of PTH alongside of hypocalcaemia and hyperphospataemia suggests PTH resistance rather than a deficiency.

59
Q

Clinical presentation of pseudo-hypoparathyroidism.

A

Syndromic appearance with short stature, round face and short 4th and 5th metacarpals.

60
Q

Pathway to determine cause of hypercalcaemia.

A
61
Q

Treatment of acute hypercalcaemia.

A

If Ca2+ is >3.5 mmol/L and symptomatic:

1 - Correct dehydration with IV 0.9% saline

2 - Bisphosphonates to prevent bone resorption by inhibiting osteoclastic activity. E.g. Pamidronate, Zoledronic acid.

3 - Chemotherapy can help in malignancy, steroids are used in sarcoidosis.

62
Q

Causes of hypocalcaemia with increased phosphate.

A

CKD

Hypoparathyroidism

Pseudohypoparathyroidism

Acute rhabdomyolysis

Hypomagnesaemia

63
Q

Causes of hypocalcaemia with normal or decreased phosphate.

A

Vit D def

Osteomalacia

Acute pancreatitis

Over hydration

Respiratory alkalosis

64
Q

Features of hypocalcaemia.

A

SPASMODIC

Spasms (Trousseau’s sign)

Perioral paraesthesiae

Anxious, irritable, irrational

Seizures

Muscle tone increased

Orientation impaired and confusion

Dermatitis

Impetigo herpetiformis

Chvostek’s sign, choreoathetosis, cataract, cardiomyopathy.

65
Q

Treatment of hypocalcaemia.

A

Calcium 5 mmol/6h PO if mild

In CKD may require alfacalcidol PO

Severe => 10 ml of 10% calcium gluconate IV over 30 min

Y3M - Diabetes & Endocrinology (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions