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My DEMS 4 > Calcium Disorders > Flashcards

Calcium Disorders Flashcards

1
Q

PTH effects

A
  • increased bone resorption
  • inc ca absorp
  • decrease calcium excretion
  • increase phosphate excretion
  • increase 1,25 Vit D (1,25 made as needed, 25 Vit D is major storage form)
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2
Q

Ca sensor receptor on

A

Parathyroid cell
Parafollicular C cell
Renal tubular cell

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3
Q

Hypercalcemic Disorders

A

-*primary hyperparathyroidism
-Hypercalcemia of Malignancy
Granulomatous Disease
Vitamin D Intoxication
Vitamin A Intoxication
Hyperthyroidism
Thiazide Diuretics
Milk-Alkali Syndrome
Immobilization
Adrenal Insufficiency
Acute Renal Failure
*Familial Hypocalciuric Hypercalcemia

*increased PTH

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4
Q

When Ca high and phos low, suggests

A

PTH problem

=primary hyperparathyroidism

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5
Q

Primary hyperparathyroidism classific

A

adenoma: 85%
hyperplasia 15%
carcinoma: less than 1%

features:
Asx (>50%)
skeletal disease
kidney disease
GI disease
psychiatric disease
("bones, stones, groans, moans")
arthritis
muscle weakness
band keratopathy
htn
anemia
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6
Q

Dx of primary hyperparathyroidism

A

elevated Ca
low Phosphate
increased serum PTH

90% sporadic
10% familial (familial HPT, MEN I, MEN IIA)

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7
Q

MEN I

A

Pituitary tumors
pancreatic islet tumors
parathyroid hyperplasia

“3 Ps”
germline mut: menin gene

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8
Q

MEN IIA

A

Medullary thyroid carcinoma
pheochromocytoma (cause severe HTN)
parathyroid hyperplasia

Germline mut: Ret gene (GDNF receptor)

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9
Q

tx of primary hyperparathyroidism

XXX

A

surgery:
adenoma- 1 gland
hyperplasia- 3.5 glands

Calcimimetic drug (suppress PTH production): Cinacalcet
Anti-resorptive bone drug:
bisphosphonate, denosumab

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10
Q

secondary hyperparathyroidism

A

elevated PTH secretion as response to stim (compensatory) (low serum Ca, or low serum phosphate, or low 1,25 Vit D)

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11
Q

Hypercalcemia of malignancy

A 
tumor types:
lung and breast cancers most common
-head/neck
kidney
bladder
panc
ovarian
multiple myeloma
lymphoma
Mediators:
PTH related peptide (PTH-RP): 90%
TGF beta
TNF
interleukin 1, interleukin 6
rankL
DKK1
1,25 OH2 Vit D
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12
Q

PTH-RP

A
  • role in Ca transport
  • first 13 aa identical to PTH, and bind to PTH receptor (osteoclastic bone resorption)
  • leads to hypercalcemia of malig
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13
Q

Dx of hypercalcemia of malignancy

A

-increased Serum Ca, decreased serum PTH

increased PTH-RP

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14
Q

Familial hypocalciuric hypercalcemia dx

A 
increased serum Ca (mild)
increased serum PTH
decreased urinary Ca
decreased urine ca/CrCl Ratio
(UCa x Pcr/Pca xUCr) less than 0.1
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15
Q

Causes of hypocalcemia

A

-assoc with elevated PTH except for hypoparathyroidism (PTH will be low)

Vitamin D Deficiency
Hypoparathyroidism*
Pseudohypoparathyroidism
Hypomagnesemia 
Renal Failure
Liver Failure
Acute Pancreatitis
Hypoproteinemia**

**Need corrected serum total Ca:Add 0.8 mg/dl to total Calcium for
every 1 g/L Albumin is less than 4 g/L

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16
Q

Features of hypocalcemia

A 
Paresthesias
Muscle Cramps
Muscle Weakness
Chvostek’s Sign
Trousseau’s Sign
17
Q

Vit D changes Ca and Phosphate in

A

same direction

18
Q

Vit D disorders

A 
Acquired Vit D def:
poor oral intake
inadequate sunlight
Acquired 1,25 Vit def:
renal disease
hypoparathyroidism
Congenital Alpha hydroxylase def: 
Vit D dep Rickets Type 1
Congenital Vit D receptor def:
Vit D dependent Rickets Type 2
19
Q

Labs for nutritional Vit D def

A 
low Ca
low phosphate
low 25 OH Vit D
increased serum PTH
increased serum alk phos (suggests osteomalacia)

Tx: high Vit D

20
Q

Hypoparathyroidism lab features

A

low serum Ca
high serum phosphate
low serum PTH

21
Q

Pseudohypoparathyroidism

A
  • inability to respond to PTH
  • sign: Albright’s hereditary osteodystrophy (4/5th metacarpal shortening)
Labs:
low Ca
high phosphate
high PTH
short 4th/5th metacarpals
22
Q

PTH signaling

A

PTH receptor

  • alpha GDP subunit
  • GDP disocciates, GTP assoc
  • alpha GTP is active, CAMP increases, PTH action

in pseudohypoparathryroidism: low PTH action due to inability to signal (alpha GDP)

My DEMS 4 (23 decks)

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