Calcium Disorders

Question 1

list the clinical features of hypercalcaemia

Answer 1

thirst 
confusion 
polyuria 
myopathy 
osteopenia
hypertension 
abdominal pain

Question 2

list the main causes of hypercalcaemia

Answer 2

hyperparathyroidism
malignancy
drugs 
TB, sarcoidosis 
high cell turnover 
FHH

Question 3

what is the best test to investigate hypercalcaemia?

Answer 3

measure PTH levels

Question 4

outline management of hypercalcaemia

Answer 4

fluid replacement
loop diuretic
bisphosphonate

Question 5

what is primary hyperparathyroidism?

Answer 5

overactivity of PT gland due to adenoma

Question 6

what is secondary hyperparathyroidism?

Answer 6

physiological response to low calcium

Question 7

what is tertiary hyperparathyroidism?

Answer 7

PT becomes autonomous after years of secondary hyperparathyroidism

Question 8

describe the PTH and calcium levels in primary hyperparathyroidism

Answer 8

PTH high

calcium high

Question 9

describe the PTH and calcium levels in secondary hyperparathyroidism

Answer 9

PTH high

calcium low

Question 10

what investigation is done for hyperparathyroidism?

Answer 10

sestamibi scan - localises adenoma

Question 11

what is FHH?

Answer 11

familial hypocalciuric hypercalcaemia

an autosomal dominant disease where CaSR is mutated

Question 12

list clinical features of hypocalcaemia

Answer 12

paraesthesia 
muscle cramps/tetany/weakness 
fatigue 
bronchospasm
chvostek sign 
trousseau sign

Question 13

what is chvostek sign in hypocalcaemia?

Answer 13

tapping over the facial nerve produces a twitch of muscle on the ipsilateral side

Question 14

what is trousseau sign in hypocalcaemia?

Answer 14

carpopedal spasm when BP cuff is inflated and held for three minutes

Question 15

what are the three main causes of hypocalcaemia?

Answer 15

hypoparathyroidism
vitamin D deficiency
chronic renal failure

Question 16

list causes of hypoparathyroidism

Answer 16

congenital (DiGeorge syndrome)
trauma
autoimmunity
low magnesium

Question 17

what would levels of calcium, phosphate, PTH and ALP be like in hypoparathyroidism?

Answer 17

calcium - low
phosphate - high
PTH - low
ALP - normal

Question 18

which diseases are extreme manifestations of vitamin D deficiency?

Answer 18

osteomalacia

ricket’s

Question 19

what would levels of calcium, phosphate, PTH and ALP be like in osteomalacia?

Answer 19

calcium - normal/low
phosphate - low
PTH - normal
ALP - high

Question 20

outline treatment for chronic vitamin D deficiency

Answer 20

vitamin D3 tablets
calcitriol
alfacalcidol

Question 21

what is pseudo-hypoparathyroidism?

Answer 21

resistance to PTH, causing hypocalcemia

Question 22

which gene has a defect in pseudo-hypoparathyroidism?

Answer 22

GNAS1

Question 23

what is pseudo-pseudo-hypoparathyroidism?

Answer 23

phenotypically, the individual has pseudo-hypoparathyroidism but biochemical aspects are normal

Question 24

outline treatment of hypocalcemia

Answer 24

IV calcium gluconate
calcium supplements
vitamin D supplements

Question 25

what are calcium, PTH, ALP and phosphate levels like in hyperparathyroidism?

Answer 25

calcium - high
PTH - high
ALP - normal/high
phosphate - normal

Question 26

what are calcium, PTH, ALP and phosphate levels like in bone malignancy?

Answer 26

calcium - high
PTH - low
ALP - high
phosphate - normal

Question 27

what are calcium, PTH, ALP and phosphate levels like in FHH?

Answer 27

calcium - high
PTH - normal/high
ALP - normal
phosphate - high

Question 28

what are calcium, PTH, ALP and phosphate levels like in hypoparathyroidism?

Answer 28

calcium - low
PTH - low
ALP - normal
phosphate - normal/high