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Y3R5: Medicine I 🩺 > L15: Hyperparathyroidism & Hypercalcemia > Flashcards

L15: Hyperparathyroidism & Hypercalcemia Flashcards

1
Q

Normal serum Ca

A

8.5 - 10.5 mg

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2
Q

Forms of Calcium In Body

A
  • Ionized Ca
  • Non-ionized Ca
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3
Q

Ionized Ca

A

50 % biologically active form responsible for Ca action.

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4
Q

Non-Ionized Ca

A

50 % subdivided into:

  • Protein bound: (40 %) of no physiological significance
  • Ca complexes in bones & teeth: (10 %)
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5
Q

Serum Ca Control is By …..

A
  • Parathormone (PTH)
  • Vit D
  • Calcitonin
  • Acid/Base Balanse
  • Glucocorticoides
  • T3,T4
  • GH
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6
Q

Normal Level of Parathormone (PTH)

A

(0. 1 - 1 ng /ml)

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7
Q

Net Effect of Parathormone (PTH)

A

↑ Ca & ↓ Po4

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8
Q

Effevts of Parathormone (PTH)

A
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9
Q

Vitamin D & Serum Ca

A
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10
Q

Effects of Vitamin D

A
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11
Q

Calcitonin & Serum Ca

A
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12
Q

Where is Calcitonin secreted from?

A

Para follicular (C-cells) of thyroid gland

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13
Q

effects of Calcitonin

A

 ↓ Osteoclastic bone resorption
 ↑ Renal excretion of Ca & Po4

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14
Q

Acid-Base Balance & ca Serum level

A

 Acidosis → ↑ ionized Ca
 Alkalosis → ↓ ionized Ca

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15
Q

Glucocorticoids & Ca Control

A

↓ Ca & Po4 absorption causing steroid induced osteoporosis.

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16
Q

T3&T4 & Ca Control

A

↓ Bone mineral density → osteoporosis in hyperthyroidism

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17
Q

Growth Hormones & Serum Ca

A
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18
Q

Table Showing Effects of PTH, Vit D & Calcitonin on Bone, Kidney & Intestine & Overall effect

A
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19
Q

Def of Hyperparathyroidism

A

Hyperparathyroidism means abnormal increase in PTH secretion

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20
Q

Etiology of Hyperparathyroidism

A
  • 1ry hyperparathyroidism
  • Familial
  • 3ry Hyperparathyroiism
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21
Q

Causes of 1ry Hyperparathyroidism

A
  • Sporadic solitary adenomas 80 to 85%
  • Multiple gland hyperplasia 10 to 15 %.
  • Parathyroid carcinoma for about 1%
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22
Q

Causes of Familial Hyperparathyroidism

A

1) Multiple endocrine neoplasia type 1 (parathyroid, pancreas and pituitary)

2) Multiple endocrine neoplasia type 2a (parathyroid, Pheochromocytoma and thyroid medullary carcinoma)

3) Familial hypocalciuric hypercalcemia (FHH).
(Characterized by hypocalciuria, mild PTH elevation and mild hypercalcemia)

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23
Q

3ry Hyperparathyroidism

A

This occurs following secondary hyperparathyroidism in case of CRF due to prolonged PTH stimulation leading to → development of autonomous adenoma.

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24
Q

CP of Hyperparathyroidism

A
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25
Q

Most Common Clinical Presentation of Hyperparathyroidism

A

The most common clinical presentation of primary hyperparathyroidism (PHPT) is asymptomatic hypercalcemia detected by routine biochemical screening.

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26
Q

Symptoms of Symptomatic Hyperparathyroidism

27
Q

Renal Manifestations of Hyperparathyroidism

A
  • polyuria, polydipsia, nephrolithiasis, nephrocalcinosis, Nephrogenic diabetes insipidus and renal tubular acidosis.
28
Q

Neuropsychiatric Manifestations of Hyperparathyroidism

A

Lack of concentration, confusion, stupor and coma.

29
Q

GIT Symptoms in Hyperparathyroidism

A

anorexia, nausea, vomiting, peptic ulcer, pancreatitis and constipation

30
Q

MSK Symptoms in Hyperparathyroidism

A

Muscle weakness, bone pain, osteoporosis and osteitis fibrosa cystica.

31
Q

CVS Manifestations in Hyperparathyroidism

A

Hypertension, bradycardia and shortened QT interval.

32
Q

Dx of Hyperparathyroidism

33
Q

Labs in Hyperparathyroidism

A

 Elevated PTH
 Hypercalcemia
 Hypophosphatemia

34
Q

Rads in Hyperparathyroidism

A

 Detection of adenoma in isotopic scanning of parathyroid gland

 Detection of osteitis fibrosa cystic, osteoporosis, kidney stones or nephrocalcinosis in X-ray.

34
Q

Others in Dx of Hyperparathyroidism

A

Other hormonal assay if MEN is suspected

35
Q

DDx of Hyperparathyroidism

36
Q

Clinical findings that favor the diagnosis of primary hyperparathyroidism

A

 an asymptomatic patient with chronic mild hypercalcemia

 a postmenopausal woman

 a normal physical examination

 no other obvious cause of hypercalcemia (such as sarcoidosis)

 no family history of hyperparathyroidism

 no evidence of multiple endocrine neoplasia

37
Q

Secondary hyperparathyroidism is characterized by …..

A

Elevated plasma PTH, hypocalcemia and hyperphosphatemia in patients with chronic renal failure.

38
Q

TTT of Hyperparathyroidism

A

1) Lowering of serum calcium: (see treatment of hypercalcemia).

2) Treatment of the cause: (surgical removal of adenoma in primary hyperparathyroidism, tertiary hyperparathyroidism and MEN).

39
Q

Def of Hypercalcemia

A
  • Hypercalcemia is a relatively common clinical problem, It results when the entry of calcium into the circulation exceeds the excretion of calcium into the urine or deposition in bone
40
Q

Causes of HyperCalcemia

A
  • Increase bone resorption
  • Increase calcium absorption
  • PTH-mediated hypercalcemia
  • PTH-independent hypercalcemia
41
Q

HyperCalcemia Due to Increased Bone Resorption

42
Q

Hypercalcemia Due to Increased Ca Absorbtion

43
Q

Hypercalcemia Due to PTH

44
Q

Hypercalcemia Not Due to PTH

45
Q

Chronic Granulomatous diseases Causing Hypercalcemia

A

TB or Sarcoidosis

46
Q

Medications Causing Hypercalcemia

47
Q

Miscellaneous Causes of Hypercalcemia

48
Q

CP of Mild Hypercalcemia

A

Nonspecific symptoms, such as constipation, fatigue, and depression

49
Q

CP of Moderate Hypercalcemia

A

Marked symptoms, including polyuria, polydipsia, dehydration, anorexia, nausea, muscle weakness

50
Q

CP of Severe Hypercalcemia

A

Calcium >14 mg/dL, there is often progression of these symptoms.

51
Q

Serum calcium should be corrected for ……, and an elevated concentration should be confirmed by repeat sampling.

52
Q
  • Additional laboratory data (including …… for possible multiple myeloma, TSH) will often lead to the correct diagnosis.
  • Also, urinary calcium excretion may be helpful in certain cases as …..
A

serum protein electrophoresis, FHH

53
Q

Evidence of osteitis fibrosa on bone films is very specific for …..

A

primary hyperparathyroidism

54
Q

TTT of Mild Hypercalcemia

A
  • Adequate hydration (at least 1.5-2.0 liters of water per day) is recommended to minimize the risk of nephrolithiasis.
  • Additional therapy depends mostly upon the cause of the hypercalcemia.
55
Q

TTT of Moderate Hypercalcemia

A
  • Acute rise of serum calcium requires more aggressive therapy as described for severe hypercalcemia
56
Q

TTT of Severe Hypercalcemia

57
Q

TTT of Severe Hypercalcemia

  • Volume Expansion
A
  • Volume expansion with isotonic saline at an initial rate of 200 to 300 mL/h that then adjusted to maintain the urine output at 100 to 150 ml/h.
58
Q

TTT of Severe Hypercalcemia

  • Calcitonin
A
  • Calcitonin (4 international units/kg) and repeat measurement of serum calcium in several hours.
59
Q

TTT of Severe Hypercalcemia

  • Bisphosphonates
A

Bisphosphonate is indicated for

  • Longer term control of hypercalcemia in patients with more severe (calcium >14 mg/dL)
  • Symptomatic hypercalcemia due to excessive bone resorption.
60
Q

TTT of Severe Hypercalcemia

  • Glucocorticoides
A
  • Glucocorticoids are effective in treating hypercalcemia due to some lymphomas, sarcoidosis, or other granulomatous diseases
61
Q

TTT of Severe Hypercalcemia

  • Dialysis
A
  • Dialysis is generally reserved for those with severe life threatening non responding hypercalcemia.
62
Q

Done

Y3R5: Medicine I 🩺 (47 decks)

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