Lecture 17 - Clinical Aspects of Hypercalcemia

Question 1

______23 is among the inhibitory factors regulating PTH secretion.

Answer 1

FGF23 (Fibroblast Growth Factor 23)

Question 2

Mnemonic for Hypercalcemia independent of PTH:

MD Grad Takes D

Answer 2

Malignant disease

Granulomatous disease

Thiazide diuretics

Hypervitaminosis D

Question 3

______ is the most common cause of outpatient hypercalcemia, while Malignancy is the most common cause seen in the hospital.

Answer 3

Hyperparathyroidism

Question 4

Urinary Ca++ is considered elevated if it is > _____mg/24hrs in females and > _____mg/24hrs in males –> indicates Hyperparathyroidism

Answer 4

300mg/24hrs

400mg/24hrs

Question 5

______-99m ______ scan is used to detect parathyroid adenomas. _______ remains as _______-99m is cleared and will reveal the adenoma.

Answer 5

Technetium-99m Sestamini scan

Sestamibi remains

Technetium-99m is cleared

Question 6

Secondary hyperparathyroidism is associated with early CKD, but it can progress to Tertiary hyperparathyroidism. What’s the difference between them?

Answer 6

Hypocalcemia in Secondary

Hypercalcemia in Tertiary

Question 7

Familial Hypocalciuric Hypercalcemia (FHH) is autosomal _____ loss of function mutation in the Ca++ sensing G-protein coupled receptor on Chief cells in the Parathyroid. What would the relative levels of Ca++ and PTH be?

Answer 7

Dominant

If the receptor is mutated, then PTH will be high and so will Ca++.

Question 8

24hr urine collection will reveal Ca++ < _____ in FHH (much less than in Hyperparathyroidism).

Answer 8

100mg/24hrs

Question 9

MEN-1 –> 3 P’s. What are they?

Answer 9

Parathyroid adenoma (90% of cases)

Pancreatic –> Gastrinoma (40%)

Pituitary –> Prolactinoma (20%)

Question 10

MEN-2A –> 2 P’s AND High levels of ______.

Answer 10

Parathyroid

Pheochromocytoma

High levels of Calcitonin bc Medullary Thyroid Cancer in 95% of MEN-2A mutations

Question 11

MEN-2B –> NO ______ tumors but HIGH _____, like with MEN-2A.

Answer 11

Parathyroid tumors

Calcitonin

Question 12

Humoral Hypercalcemia of Malignancy –> look for unexplained ______ (caused by PTHrP) and Low ______ in a hospitalized patient.

Answer 12

Hypercalcemia

PTH

Question 13

Multiple Myeloma can be a cause of Local Osteolytic Hypercalcemia –> _____ is NOT elevated here.

Breast Cancer can also be a cause –> _____ IS elevated here WITH bony mets. _____ cell carcinoma is similar but WITHOUT bony mets.

Answer 13

PTHrP

PTHrP

Squamous cell carcinoma