May 24, 2016 - Hypercalcemia

Question 1

Common Causes of Hypercalcemia

Answer 1

Hyperparathyroidism

Cancer

Question 2

Calcium and Albumin

Answer 2

For every drop in 10 of albumin, you need to add 0.2 to the calcium.

Question 3

Malignancy and Hypercalcemia

Answer 3

Osteolytic metastases

Tumour production of bone resorbing substances (RANKL)

PTH-rp (mimics PTH)

Question 4

Vitamin D Overdose

Answer 4

In VERY high amounts, calcidiol can mimic calcitriol.

Question 5

Sarcoidosis and Calcium Uptake

Answer 5

Sarcoidosis upregulates 1-a-hydroxylase in the kidney which converts calcidiol to calcitriol.

In the presence of sarcoidosis, patients can become hypercalcemic.

Question 6

Approach to Hypercalcemia

Answer 6

1. Are you taking calcium / vitamin D / thiazides
2. Check PTH… if high –> hyperparathyroid
3. Check cancer
4. Check sarcoidosis
5. Get help

Question 7

Primary Hyperparathyroidism

Answer 7

Solitary benign adenoma (85%)

4-gland parathyroid hyperplasia (15%)

Parathyroid carcinoma (<1%)

Question 8

Features of Primary Hyperthyroidism

Answer 8

1. Bone resorption
2. Phosphate loss
3. Calcium retention
4. Increases 1-a-hydroxylase

Question 9

Indications for Primary Hyperthyroidism Surgery

Answer 9

Very high serum calcium

Presence of kidney stones

CNS derangement

Age < 50

Parathyroid related bone disease

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