10: Disorders of calcium metabolism Flashcards Preview

Endocrine Week 4 2017/18 > 10: Disorders of calcium metabolism > Flashcards

Flashcards in 10: Disorders of calcium metabolism Deck (46)
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1

Which chemicals increase blood calcium?

PTH

Vitamin D

2

How do blood calcium levels increase?

Absorption from gut

Moves from bone to blood

Reabsorption from kidneys

3

How is calcium excreted?

Kidneys

4

Which gland regulates calcium concentration?

Parathyroid gland

5

Which receptors on parathyroid glands sense calcium concentration?

Calcium sensing receptors

6

How is Vitamin D obtained?

Diet (oily fish, red meat and eggs)

Sunlight

7

What is the mnemonic for hypercalcaemia symptoms?

Stones (renal stones)

Bones (osteoporosis)

Groans (abdominal pain)

Psychic moans (depression)

add on polydipsia and polyuria as well

8

What are the acute symptoms of hypercalcaemia?

Polydipsia

Polyuria

Confusion

9

What is seen in chronic hypercalcaemia?

Myopathy

Osteoporosis > Fragility fracture

Hypertension

Abdo pain - pancreatitis, ulcers, kidney stones

10

What is measured to diagnose hypercalcaemia itself?

Serum calcium

11

What are the two most common causes of hypercalcaemia?

Primary hyperparathyroidism

Malignancy

12

Which drugs cause hypercalcaemia?

Vit D - causes inc. calcium absorption, reabsorption and transfer from bones

Thiazide diuretics - increase calcium reabsorption from kidneys

13

Which granulomatous diseases can cause hypercalcaemia?

Sarcoidosis

TB

14

(High / low) bone turnover causes hypercalcaemia.

High bone turnover

so diseases like Paget's

15

Which tests are done to diagnose hyperparathyroidism?

Raised serum calcium

Raised PTH (or inappropriately normal for Ca levels)

Increased urine calcium secretion

16

How does malignancy cause hypercalcaemia?

Bone destruction

PTHomas

Inflammatory factors activate osteoclasts

17

Which liver enzyme will be elevated in hypercalcaemia secondary to malignancy?

ALP

18

How is suspected malignancy investigated?

Imaging - X-ray, CT, MRI

Nuclear imaging - isotope bone scan

19

How is hypercalcaemia treated?

Fluid resuscitation if dehydrated

LOOP diuretics (thiazides cause hypercalcaemia)

Bisphosphonates to reduce osteoclast activity

If granulomatous disease, steroids

20

Which type of scan is used to view the activity of the thyroid and parathyroid together?

Sestamibi scan

21

What is the only definitive treatment for hyperparathyroidism?

Surgery

i.e parathyroidectomy

22

If surgery isn't appropriate, how is hyperparathyroidism treated?

No treatment available

23

What are some complications of hyperparathyroidism?

Bone disease inc. osteoporosis BONES

Peptic ulcers GROANS

Renal stones STONES

Depression PSYCHIC MOANS

24

What is primary hyperparathyroidism?

Which PTH and Ca levels would you see?

Overactivity of parathyroids due to adenoma/carcinoma or hyperplasia

Raised PTH, raised Ca

25

Which genetic syndromes are associated with primary hyperparathyroidism?

MEN-1, MEN-2A

causing parathyroid tumours which secrete TSH, leading to hypercalcaemia

26

What is secondary hyperparathyroidism?

Which PTH and Ca levels would you see?

Physiological response to low calcium levels e.g in chronic kidney failure

Low Ca, raised PTH

27

What is tertiary hyperparathyroidism?

Which PTH and Ca levels would you see?

Autonomous parathyroids after years of secondary

Ca raised, PTH raised

28

Why must you check urinary calcium levels as well as blood calcium when diagnosing hypercalcaemia??

Hypercalcaemia w/ low urinary excretion of calcium indicates FAMILIAL HYPOCALCIURIC HYPERCALCAEMIA, a genetic condition

29

What is the problem in hypocalciuric hypercalcaemia?

Calcium sensing receptor on parathyroid gland has higher set point for calcium

So higher Ca conc. required before PTH is switched off

30

What are the symptoms of hypocalcaemia?

Paraesthesia

Muscle pain, tetany and weakness