Hypercalcemia

Question 1

Clinical manifestations of hypercalcemia

Answer 1

Cognitive dysfunction • Polyuria with resultant polydipsia • If severe or very elderly: • Volume depletion, circulatory
instability • Abdominal pain (kidney stones,
constipation) • Fatigue

Question 2

key hyperCa2+ dx outpatient. inpatient?

Answer 2

outpatient; hyperparathyroidism

inpatient: cancer

Question 3

some calcium is bound to albumin. When you are sick, you can be hypercalcemic because you don’t have enough albumin to bind free calcium. What is the general adjustment you have to do for calcium if you have a chnage in albumin?

Answer 3

for every 10gram drop below 40 of albumin, ad 0.2mmol/L to total caclium. OR you can get an ionized calcium

Question 4

3 key malignancy related factors that can cause hypercalcemia

Answer 4

osteolytic metastases– lung, prostate

tumor production of bone resorbing substances (ex/ RANKLE) – like in multiple myeloma

• PTH-rp secretion that basically is PTH, increaseing Ca2+ levels- like in lung acancer.

Question 5

after looking for malignancy and ruling out hyperparathyroidism by doing a PTH. you look at the inactive vitamin D levels. If its high, and the person has hypercaclemia, what is the dx?

Answer 5

a vitamin D overdose.

Question 6

PTH affect on 1ahydroxylase

Answer 6

activates it. Will then cause inactive vitamin D to activate, causing an increase in CA2+

Question 7

how does granulomatous disease affect calcium levels?

Answer 7

recall; PTH activates 1aH, allowing for the production of1-25VITD, which increases calcium. if you have hyperparathyroidism, you will have increase calcium because of increased PTH.

granulomatous disease also activates 1AH regardless of what the PTH levels are, so you will have hypercaclemia that is autonomous to the parathyroid galdn function.

Question 8

meds to consider after seeing that active vitamin D levels are normal.

Answer 8

1. calcium intake; are they taking milk of magnesia?
2. thiazides; acts on the ascending loop of henle and reduces renal calcium losses

Question 9

if you suspect granulomatous idsease causes hypercalcemia, what should you next order

Answer 9

CXR and 1,25 D if not done yet

Question 10

Question 11

disease specific therapy if granulomatous disease or vitamin D toxicity is suspected

Answer 11

glucocorticoids

Question 12

main cause of primary hyperparthyroidism

Answer 12

usually its due to a benign parathyroid adenoma

Question 13

Indications for surgery for primary hyperthyroidism

Answer 13

Question 14

non surgical option for hyperparathyroidism

Answer 14

1. life style; avoid smoking, add excersise for bone preservation
2. avoid exacerbating factors like thiazides or fluid restriction
3. bone preserving agents like estrogen in women, or bisphosphonates