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Endocrinology > Calcium Balance Clinical > Flashcards

Calcium Balance Clinical Flashcards

(51 cards)

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1
Q

What are some dietary sources of calcium?

A

Milk
Cheese
Green leafy vegetables

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2
Q

What are the functions of calcium?

A

Bone formation
Cell division and growth
Muscle contraction
Neurotransmitter release

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3
Q

What % of calcium is bound to albumin?

A

40-45%

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4
Q

What is the normal range of calcium?

A

2.2-2.6 mmol/l

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5
Q

What effect does increased albumin have on free calcium?

A

Decreases it

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6
Q

What are good sources of vitamin D?

A

Sun
Oily fish
Eggs

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7
Q

Where do the parathroid glands lie?

A

On the posterior aspect of the neck

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8
Q

How many parathyroid glands are there usually?

A

4

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9
Q

What hormone does the parathyrod gland secrete?

A

PTH

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10
Q

What does PTH control?

A

Calcium levels

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11
Q

When is PTH secreted in response to?

A

To a fall in calcium

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12
Q

What is the direct effect of PTH?

A

Promots reabsorption of calcium from the renal tubules and bone

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13
Q

What does PTH mediate the conversion of?

A

Vitamin D from its inactive to its active form

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14
Q

What are the symptoms of acute hypocalcaemia?

A 
Paresthesia 
Muscle twitching 
Increase in muscle tone 
Seizures 
Laryngo and bronchospasm 
Prolonged QT interval Hypotension 
Papilloedema 
Trousseau's sign 
Chovstek's signs
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15
Q

Below what level will symptoms of hypocalcaemia usually present?

A

1.0 mmol/L

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16
Q

What is Chovstek’s Sign?

A

As the patients face is flicked the corner of the motuh spasms

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17
Q

What is Trosseau’s sign?

A

As BP is being checked the hand claws up

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18
Q

Why might someone with a recent thyroidectomy present with hypocalcaemia?

A

Due to the parathyroid glands being disturbed

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19
Q

Why might someone with a recewnt thyroidectomy present with hoarseness of voice?

A

As the reuccrent laryngeal nerve runs through the thyroid gland and can be damaged during surgery

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20
Q

What drug can typically cause Magensium deficiency?

A

Meprozol

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21
Q

What should be asked in a history with suspected hypocalcaemia?

Study These Flashcards
A 
Ca and Vit D intake 
Neck surgery 
Autoimmune disorders
Medications
FH
22
Q

What might be seen on examination from neck surgery?

23
Q

What investigations should be done for hypocalcaemia?

Study These Flashcards
A 
ECG 
Serum calcium 
Albumin 
Phosphate 
PTH 
U&E's
Vitamin D 
Magnesium
24
Q

What can cause hypoparathyroidism?

Study These Flashcards
A 
Renal agnesis 
Destructin of the glands 
Infiltration 
Redcued secretion of PTH 
Resistance to PTH 
Vitamin D deficiency
25
What causes pseudohypoparathyroidism?
Failure of target cells to respond to PTH
26
What is characterisitc (clincial sign wise) of pseudohypoparathyroidism?
Short 4th and 5th finger
27
What is PTH levels in pseudohypoparathyroidism?
They are elevated
28
What is the treatment for mild hypocalcaemia?
Commence oral calcium tablets If post thyroidectomy repeat after 24 hours Stsrt vit D tablets if deficient If Mg2+ low then remove precipitatin gdruug and replace Mg2+
29
Rx for severe hypoglycaemia?
Medical emergency IV calcium gluconate Treat underlying cause
30
What is treatment for vitamain D replacement?
dietary advice | Tablets combined with calcium
31
When should vitamin D not be prescribed?
In severe renal impairment
32
Why should vitamin D not be prescirbed in severe renal impairment?
Because vit D requires hydroxylation by the kidneys to its active form
33
What is the key lood test for hypocalcaemia?
PTH
34
What are the most common causes of hypercalcaemia?
Primary hyperparathyroidism | Hypercalcaemia of malignancy
35
When PTH is low and there is hypercalcaemia is the cause primary or secondary?
Secondary
36
What are the symptoms of hypercalcaemia?
``` Polyruria Polydispia Nephrolothiasis Anorexia Nausea and vomiting Constipation Muscle weakness Decreased concentration Shortening of the QT interval ```
37
What are the investigations for hypercalcaemia?
``` Ca PO4 Albumin Myeloma screen Serum ACE PTH Alk phos Consider an ECG U&Es ```
38
Does Primary Hyperparathyroidism mainly affect women or men?
Female
39
What is primary hyperparathyroidism caused by?
Parathyroid adenoma MEN type 1 or 2A Parathyroid carcinoma
40
What are the investigations for primary hyperparathyroidism?
``` Ca PTH U&E’s Abdominal imaging DEXA Exc FHH Vitamin D Parathyroid USS ```
41
What are the indications for surgery in primary hyperparathyroidism?
``` Presence of symptoms Serum calcium >0.25 mmol/L above upper range limit Osteoporosis eGRF<60 or presence of kidney stones <50 years ```
42
What is the medical management of primary hyperparathyroidism?
Generous fliud intake | Cincacalet
43
What is the action of cinaclcet?
Mimics the effect of calcium on the calcium sensing receptors on chief cells Leading to a fall in PTH and consequently a fall in calcium levels
44
What is FHH?
Autosomal dominant disorder of the calcium sensing receptor
45
What is MEN type 1?
MEN 1 is characterised by the combination of parathyroid tumours, pancreatic islet cell tumours, and anterior pituitary tumours
46
When does MEN type1 usually present?
2nd to 4th decade of life
47
What is the most common presentation of MEN type 1?
Primary hyperparathyroidism
48
What is the management for hyperparathyroidism?
Rehydration Consider dialysis if severe kidney failure IV biphosphonates
49
What is MEN type 2A?
Multiple endocrine neoplasia type 2 (MEN2) is a hereditary condition associated with three primary types of tumors: medullary thyroid cancer, parathyroid tumors, and pheochromocytoma.
50
Where is the mutation in MEN type 1?
MENIN
51
Where is the mutation in MEN type 2A?
RET

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