parathyroid & calcium Flashcards

1
Q

what are the classic symptoms of hypercalcaemia?

A

Bones (pain)
Stones
Abdominal Groans
Psychic Moans

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2
Q

what are the acute symptoms of hypercalcaemia?

A

Thirst
Dehydration
Confusion
Polyuria

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3
Q

what are the chronic symptoms of hypercalcaemia?

A

Myopathy
Fractures
Osteopaenia
Depression
Hypertension
Pancreatitis
DU
Renal calculi

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4
Q

what are the main causes of hypercalcaemia?

A

primary hyperparathyroidism
malignancy
(can also be caused by vit d & thiazides)

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5
Q

what is the first line investigation once you know it is hypercalcaemia?

A

parathyroid hormone level (PTH)

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6
Q

what does elevated PTH indicate?

A

primary hyperparathyroidism

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7
Q

what does depressed PTH indicate?

A

not hyperparathyroidism - likely malignancy but think broadly

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8
Q

what test results indicate primary hyperparathyroidism?

A

Raised serum calcium
Raised serum PTH (or inappropriately normal)
Increased urine calcium excretion
–>Ensure Vitamin D replete

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9
Q

how do you diagnose hypercalcaemia of malignancy?

A

Raised calcium and alkaline phosphatase
X-ray, CT, MRI, PET
Isotope Bone Scan

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10
Q

what is the treatment for acute hypercalcaemia?

A

fluids
consider loop (not thiazide) diuretics once rehydrated
bisphosphonates
steroids
chemotherapy in malignancy may reduce calcium

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11
Q

what is the management of primary hyperparathyroidism?

A

surgery
cinacalet (calcium mimetic) - used if unfit for surgery

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12
Q

what are the indications for parathyroidectomy?

A

end organ damage (bone disease, gastric ulcers, renal stones, osteoporosis)
very high calcium
age < 50
eGFR < 60 ml/min

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13
Q

what causes primary hyperparathyroidism?

A

primary overactivity of the parathyroid gland e.g. adenoma

has high calcium and high PTH

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14
Q

what causes secondary hyperparathyroidism?

A

physiological response to low calcium or vit d

has low calcium and high PTH

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15
Q

what causes tertiary hyperparathyroidism?

A

Parathyroid becomes autonomous after many years of overactivity e.g renal failure

has high calcium and high PTH

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16
Q

what genetic syndromes will have hyperparathyroidism?

A

MEN1/2 - parathyroid adenoma with hypercalcaemia

17
Q

what are the symptoms of hypocalcaemia?

A

Paraesthesia - fingers, toes, perioral
Muscle cramps, tetany
Muscle weakness
Fatigue
Bronchospasm or laryngospasm
Fits
Chovsteks sign (tapping over facial nerve)
Trousseau sign (carpopedal spasm)
ECG: QT prolongation

18
Q

what is the treatment for acute hypocalcaemia?

A

Emergency:
IV calcium gluconate 10 ml, 10% over 10 mins (in 50ml saline or dextrose)

Infusion (10ml 10% in 100 ml infusate, at 50 ml/h)

19
Q

what are the causes of hypoparathyroidism?

A

Congenital absence (DiGeorge syndrome)
Destruction (surgery, radiotherapy, malign)
Autoimmune
Hypomagnesaemia
Idiopathic

20
Q

what can cause hypocalcaemia?

A

hypoparathyroidism

21
Q

what is the long term management of hypocalcaemia?

A

Calcium supplement : > 1-2 g per day
Vitamin D
Tablets:
1 alphacalcidol 0.5-1 mcg (sometimes more)
Depot injection:
Cholecalciferol 300,000 units 6 monthly

22
Q

what causes hypomagnesaemia?

A

Alcohol
Drugs
Thiazides
PPI
GI illness
Pancreatitis
Malabsorption

23
Q

what is pseudohypoparathyroidism?

A

genetic disorder (dysfunction of G protein (Gs alpha subunit)- Gene= GNAS 1
Low calcium, but PTH concentrations are elevated
Due to PTH resistance
Bone abnormalities (McCune Albright)
Obesity
Subcutanous calcification
Learning Disability
Brachdactyly (4th metacarpal)

24
Q

what is pseudo-pseudohypoparathyroidism?

A

Albright’s Herditary Osteodystrophy But…
No alteration in PTH action and thus Normal calcium