parathyroid & calcium Flashcards
what are the classic symptoms of hypercalcaemia?
Bones (pain)
Stones
Abdominal Groans
Psychic Moans
what are the acute symptoms of hypercalcaemia?
Thirst
Dehydration
Confusion
Polyuria
what are the chronic symptoms of hypercalcaemia?
Myopathy
Fractures
Osteopaenia
Depression
Hypertension
Pancreatitis
DU
Renal calculi
what are the main causes of hypercalcaemia?
primary hyperparathyroidism
malignancy
(can also be caused by vit d & thiazides)
what is the first line investigation once you know it is hypercalcaemia?
parathyroid hormone level (PTH)
what does elevated PTH indicate?
primary hyperparathyroidism
what does depressed PTH indicate?
not hyperparathyroidism - likely malignancy but think broadly
what test results indicate primary hyperparathyroidism?
Raised serum calcium
Raised serum PTH (or inappropriately normal)
Increased urine calcium excretion
–>Ensure Vitamin D replete
how do you diagnose hypercalcaemia of malignancy?
Raised calcium and alkaline phosphatase
X-ray, CT, MRI, PET
Isotope Bone Scan
what is the treatment for acute hypercalcaemia?
fluids
consider loop (not thiazide) diuretics once rehydrated
bisphosphonates
steroids
chemotherapy in malignancy may reduce calcium
what is the management of primary hyperparathyroidism?
surgery
cinacalet (calcium mimetic) - used if unfit for surgery
what are the indications for parathyroidectomy?
end organ damage (bone disease, gastric ulcers, renal stones, osteoporosis)
very high calcium
age < 50
eGFR < 60 ml/min
what causes primary hyperparathyroidism?
primary overactivity of the parathyroid gland e.g. adenoma
has high calcium and high PTH
what causes secondary hyperparathyroidism?
physiological response to low calcium or vit d
has low calcium and high PTH
what causes tertiary hyperparathyroidism?
Parathyroid becomes autonomous after many years of overactivity e.g renal failure
has high calcium and high PTH
what genetic syndromes will have hyperparathyroidism?
MEN1/2 - parathyroid adenoma with hypercalcaemia
what are the symptoms of hypocalcaemia?
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
what is the treatment for acute hypocalcaemia?
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)
what are the causes of hypoparathyroidism?
Congenital absence (DiGeorge syndrome)
Destruction (surgery, radiotherapy, malign)
Autoimmune
Hypomagnesaemia
Idiopathic
what can cause hypocalcaemia?
hypoparathyroidism
what is the long term management of hypocalcaemia?
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
what causes hypomagnesaemia?
Alcohol
Drugs
Thiazides
PPI
GI illness
Pancreatitis
Malabsorption
what is pseudohypoparathyroidism?
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)
what is pseudo-pseudohypoparathyroidism?
Albright’s Herditary Osteodystrophy But…
No alteration in PTH action and thus Normal calcium
