Calcium Disorders Lecture Powerpoint

Question 1

Role of parathyroid hormone

Answer 1

Maintain extracellular fluid ca2+ balance, acts directly on bone and kidney, acts indirectly on gut thru vit d production

Question 2

Differential for hypercalcemia (6)

Answer 2

• PTH related
• Malignancy
• Vit D intoxication
• Hyperthyroidism
• thiazide diuretics
• Excessive alkaline agent ingestion

Question 3

Hypercalcemia clinical features (4)

Answer 3

• asymptomatic
• fatigue, depression
• N/V
• stone formation

Question 4

Primary hyperparathyroidism

Answer 4

Inappropriate elevation of PTH levels in relation to elevated Ca2+ levels, most often caused by a solitary adenoma

Question 5

Treatment indications for primary hyperparathyroidism in asymptomatic patients (4)

Answer 5

• Only if serum Ca2+ >1.0mg/dL above normal
• or if osteoporosis development
• or if age less than 50
• or if kidney impairment

Question 6

Treatment for primary hyperparathyroidism first choice and backup option

Answer 6

• Surgical removal using intraoperative rapid PTH assays between removing one parathyroid gland or in the case of 4 gland hyperplasia remove 3.5 glands and autotransplant remnant into forearm
• Cinacalcet (sensipar) that is a calcimimetic agent that lowers PTH levels

Question 7

Chvostek sign

Answer 7

Light tap on facial nerve sees corner of mouth twitch in response, common in normal individuals but bilateral can indicate hypocalcemia

Question 8

Trousseau’s sign

Answer 8

Pump blood pressure cuff above systolic and retain it until the patient cramps up due to acidosis, indicative of hypocalcemia

Question 9

Differential for hypocalcemia (4)

Answer 9

• chronic renal failure
• hypoparathyroidism
• vit D deficiency
• transient

Question 10

Hypocalcemia signs and symptoms (3)

Answer 10

• muscle spasms, convulsions
• mental status change
• positive chvostek and trousseau sign

Question 11

Vit D action

Answer 11

Increases intestinal ca2+ absorption and increases effect of PTH on the bone, sourced from sunlight or from fortified foods, converted to active form at liver and kidney and acts on gut

Question 12

Common causes of vit D deficiency (3)

Answer 12

• GI malabsorption
• Cirrhosis or kidney failure
• steroids/anticonvulsants

Question 13

Vit D insufficiency value vs deficiency value

Answer 13

Insufficiency >20 but <30 ng/mL and deficiency <20 ng/mL

Question 14

Vit D deficiency screening (3)

Answer 14

• Those without regular sun exposure
• Gastric surgery
• osteoporosis eval

Question 15

Vitamin D replacement therapy

Answer 15

Vit D3 50,000 IU weekly for 4-6 weeks, then maintenance 800-2000 IU daily

Question 16

Vitamin D repletion benefits (2)

Answer 16

• Reduction in fracture risks

- Immune system benefit