What is the most common cause of hypercalcemia, and what are the symptoms
Primary hyperparathyroidism - normally asymptomatic
If symptomatic and bad, think cancer releasing PTH
What are other causes besides hyperparathyroidism for high calcium
Vitamin D intoxication, sarcoidosis, thiazide diuretics, hyperthyroidism, metastases to bones
What is the presentation of acute symptomatic hypercalcemia
Confusion, stupor, lethargy, constipation
CV - short QT
Bones - osteoporosis
Renal - nephrolithiasis, diabetes insipidus, renal insufficiency
What is the treament of acute hypercalcemia
Saline hydration with loop diuretic (furosemide)
Also bisphosphonates: Pamidronate, zoledronic acid
Second line after they don’t work: Calcitonin (not calacalcet, which inhibits PTH but doesnt help in malignancy)
Dialysis if renal failure
What is the treatment of acute hypercalcemia if the source is sarcoidosis or other granulomatous diseases
Prenisone
If hyperparathyroidism is the cause of high calcium, what are the 3 ways this can occur
Solitary adenoma - 80%
Hyperplasia of all 4 glands (15%)
Parathyroid malignancy - 1%
What is the presentation if hyperparathyroidism is the cause of high calcium
More slower manifestations rather than acute symptoms, such as osteoporosis, nephrolithiasis and renal insufficiency, NV, muscle weakness, abdominal pain, peptic ulcer disease
What are the diagnostic tests you can do for hyperparathyroidism
High calcium, high PTH, high Cl, EKG with short QT
DEXA scan
What is the main treatment for hyperparathyroidism
Surgical removal
What are four causes of hypocalcemia
Hypoparathyroidism - prior neck surgery
Hypomagnesemia - results in low PTH
Renal failure - Due to less 1,25 vit D
Low albumin states - Every point decrease in albumin means calcium decreases by 0.8 (free calcium normal so no symptoms)
What is the presentation of someone with hypocalcemia
Chostek sign, Trousseau sign, carpopedal spasm, periooral numbness, seizures
What are diagnostic tests that you can use for hypocalcemia
EKG - prolonged QT
Slit lamp - early cataracts
What is the treatment for hypocalcemia
Replace calcium and vitamin DIfmild - oralIf severe - IV