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Endocrinology > Calcium > Flashcards

Flashcards in Calcium Deck (19):
1

Describe symptoms of hypercalcaemia.

Acute: thirst, dehydration, confusion, polyuria
Chronic: myopathy, osteopaenia, fractures, depression, hypertension, abdominal pain- pancreatitis, ulcers, renal stones

2

Name the causes of hypercalcaemia.

Primary hyperparathyroid
malignancy
vit d, thiazides
granulomatous disease eg sarcoid or TB
Familial hypocaliuric hypercalcaemia

3

How is primary hyperparathyroid diagnosed?

Raised serum calcium
Raised serum PTH (or inappropriately normal)
Increased urine calcium excretion

4

How is hypercalcaemia due to malignancy diagnosed?

Raised serum calcium
Raised serum PTH (or inappropriately normal)
Increased urine calcium excretion

5

Describe the acute treatment of hypercalcaemia.

Fluids- rehydrate with 0.9% saline 4-6L in 24hours
Consider loop diuretics once rehydrated- avoid thiazides
Bisphosphonates- single dose will lower Ca over 2-3d, maximum effect at 1 week
Steroids occasionally used e.g Pred 40-60mg/day for sarcoidosis
Salmon calcitonin- rarely used
Chemotherapy may reduce calcium in malignant disease e.g. myeloma

6

What are indicationds for parathyroidectomy?

End Organ Damage:
Bone disease (Osteitis Fibosa et cystica; brown tumours/ pepper pot skull)
Gastric ulcers
Renal stones
Osteoporosis

Very high Calcium (>2.85mmol/l)
Under age 50
eGFR < 60 mL/min

7

Describe calcium and PTH levels in all types of hyperparathyroidism.

Primary: calcium and PTH raised
Secondary: calcium LOW and PTH raised
Tertiary: calcium and PTH raised

8

What genetic factors might cause hyperparathyroid?

MEN1/ 2
FHPT

9

What ECG sign may suggest hypocalcaemia?

QT prolongation

10

Describe symptoms of hypocalcaemia.

Paraesthesia - fingers, toes, perioral
Muscle cramps, tetany
Muscle weakness
Fatigue
Bronchospasm or laryngospasm
Fits
Chovsteks sign (tapping over facial nerve)
Trousseau sign (carpopedal spasm)

11

List causes of hypocalcaemia

Hypoparathyroidism
Vitamin D deficiency (osteomalacia, rickets)
Chronic Renal failure

12

How should acute hypocalcaemia be treated?

Emergency: IV calcium gluconate 10 ml, 10% over 10 mins (in 50ml saline or dextrose)
Infusion (10ml 10% in 100 ml infusate, at 50 ml/h)

13

Long term management of hyperparathyroidism?

Calcium supplement : > 1-2 g per day
Vitamin DTablets: 1alpha calcidol 0.5-1 mcg Depot injection: Cholecalciferol 300,000 units 6 monthly

14

What causes pseudohypoparathyroidism?

GENETIC Defect (dysfunction of G protein (Gs alpha subunit)- Gene= GNAS 1

15

What are the calcium and PTH levels in pseudohypoparathyroidism?

calcium low, PTH high

16

Pseudo-pseudohypoparathyroidism exists - what is the difference here?

calcium is normal

17

What is Paget's disease?

Abnormality of bone remodelling
Thick but weak bone

18

How is Paget's diagnosed?

X-rays
Raised alkaline phosphatase
Isotope bone scan

19

How is Paget's treated?

Oral bisphosphonate, high dose (2-6month): Risedronate, Alendronate
Calcitonin (SC inj or nasal)