Disorders of Calcium

Question 0

Triad of Kidney stones, bone disease, peptic ulcer or pancreatitis
High blood calcium with high PTH
Blood phosphorous usually low 
24 h urine calcium high or high normal 
Bone mineral density low

Answer 0

Primary hyperparathyroidism

Question 1

Fatigue, confusion, depression, lethargy, coma, polyurethane, nocturia, constipation, pancreatitis, dyspepsia, weakness

Answer 1

General symptoms of hypercalcemia

Question 2

Hypercalcemia, low blood phosphate and suppressed PTH

Answer 2

Hypercalcemia of malignancy due to PTHrP

Question 3

High blood calcium, low PTH, high normal or elevated phosphate
Low vitamin d

Answer 3

Hypercalcemia of malignancy with cytokines

Question 4

High calcium, low PTH, high blood phosphate

Answer 4

Vitamin d toxicity

Question 5

PTH high normal, low urinary calcium

Answer 5

Familial hypocalciuric hypercalcemia

Don’t remove glands - it will just recur

Question 6

Low blood calcium, high phosphate, low PTH

Answer 6

Hypoparathyroidism

Question 7

Low calcium, high phosphorous, high PTH

Answer 7

Psuedohypoparathyroidism

Question 8

Low calcium and low phosphorous in blood

Answer 8

Lack of vitamin d
Decreased 25 OHD
Decreased 1,25(OH)2-D (kidney disease, 1alpha hydroxylase deficiency)

Question 9

Low calcium and phosphorous, high 1,25(OH)2D

Answer 9

Resistance - inactivating mutation of vitamin d receptor causing hypocalcemia

Question 10

Neuromuscular excitability - chvosteks and trousseaus 
Muscle cramps the tetany
Paresthesia
Laryngo and bronchospasm
Seizure
Arrhythmia

Answer 10

Signs and symptoms of hypocalcemia

Question 11

What are the causes of osteomalacia?

Answer 11

Vitamin d deficiency or resistance
Hypophosphatemia - FGF 23 increase renal loss and suppresses vitamin d
Drug induced - anticonvulsants enhance catabolism of vitamin d, phosphate binders (aluminum)

Question 12

Diffuse bone pain, muscle tenderness and weakness, waddling gait, fractures and psuedofractures in usual and unusual locations (ribs, sternum, scapula, pelvis, femoral shafts, metatarsals - not in osteoperosis)

Answer 12

Osteomalacia

Question 13

Decreased growth, widening of epiphysis, rachitic rosary, deformation of bones, tooth enamel defects

Answer 13

Rickets

Question 14

What lab values are seen in osteomalacia?

Answer 14

Elevated alk phos and/or PTH

Low blood calcium and/or phosphate