Parathyroidism and Hypercalcaemia

Question 1

Presentation of hyperparathyroidism

Answer 1

BONES, STONES, ABDOMINAL GROANS, PSYCHIC MOANS

-Bone pain
-Renal colic, polydipsia, polyuria
-Constipation, nausea, peptic ulceration, pancreatitis
-Depression, anorexia, hypertension, fatigue

Question 2

Investigation of hyperparathyroidism

Answer 2

-Raised calcium, low phosphate, elevated plasma parathyroid hormone.
-Technetium- MIBI subtraction scan.
-X-ray= pepper pot skull.

Question 3

Management of hyperparathyroidism

Answer 3

-Surgical removal of parathyroid glands if hypercalcaemic and symptomatic.
-Calcimimetic (not suitable for surgery).

Question 4

Presentation of hypoparathyroidism

Answer 4

-Tetany (muscle twitching, cramping, spasm)
-Perioral paraesthesia
-Trousseau’s sign (carpal spasm)
-Chvostek’s sign (tapping over parotid causes facial muscles to twitch)
-Depression
-Cataracts
-Prolonged QT interval.

Question 5

Investigation of hypoparathyroidism

Answer 5

-Low calcium, high phosphate, decrease hypoparathyroidism

Question 6

Management of hypoparathyroidism

Answer 6

Alfacalcidol

Question 7

Investigation of hypercalcaemia (including malignancy)

Answer 7

-Shortened QT interval on ECG
-Raised calcium
-PTH
-PTHrP (squamous cell lung cancer)

Question 8

Management of hypercalcaemia

Answer 8

-Rehydration with normal saline (3-4L)
-Bisphosphonates
-Calcitonin
-Steroids in sarcoidosis.
-Loop diuretics cannot tolerate rehydration.