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Y3R5: Medicine I 🩺 > L15: Hyperparathyroidism & Hypercalcemia > Flashcards

L15: Hyperparathyroidism & Hypercalcemia Flashcards

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1
Q

Normal serum Ca

A

8.5 - 10.5 mg

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2
Q

Forms of Calcium In Body

A
  • Ionized Ca
  • Non-ionized Ca
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3
Q

Ionized Ca

A

50 % biologically active form responsible for Ca action.

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4
Q

Non-Ionized Ca

A

50 % subdivided into:

  • Protein bound: (40 %) of no physiological significance
  • Ca complexes in bones & teeth: (10 %)
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5
Q

Serum Ca Control is By …..

A
  • Parathormone (PTH)
  • Vit D
  • Calcitonin
  • Acid/Base Balanse
  • Glucocorticoides
  • T3,T4
  • GH
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6
Q

Normal Level of Parathormone (PTH)

A

(0. 1 - 1 ng /ml)

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7
Q

Net Effect of Parathormone (PTH)

A

↑ Ca & ↓ Po4

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8
Q

Effevts of Parathormone (PTH)

A
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9
Q

Vitamin D & Serum Ca

A
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10
Q

Effects of Vitamin D

A
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11
Q

Calcitonin & Serum Ca

A
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12
Q

Where is Calcitonin secreted from?

A

Para follicular (C-cells) of thyroid gland

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13
Q

effects of Calcitonin

A

 ↓ Osteoclastic bone resorption
 ↑ Renal excretion of Ca & Po4

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14
Q

Acid-Base Balance & ca Serum level

A

 Acidosis → ↑ ionized Ca
 Alkalosis → ↓ ionized Ca

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15
Q

Glucocorticoids & Ca Control

A

↓ Ca & Po4 absorption causing steroid induced osteoporosis.

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16
Q

T3&T4 & Ca Control

A

↓ Bone mineral density → osteoporosis in hyperthyroidism

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17
Q

Growth Hormones & Serum Ca

A
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18
Q

Table Showing Effects of PTH, Vit D & Calcitonin on Bone, Kidney & Intestine & Overall effect

A
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19
Q

Def of Hyperparathyroidism

A

Hyperparathyroidism means abnormal increase in PTH secretion

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20
Q

Etiology of Hyperparathyroidism

A
  • 1ry hyperparathyroidism
  • Familial
  • 3ry Hyperparathyroiism
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21
Q

Causes of 1ry Hyperparathyroidism

A
  • Sporadic solitary adenomas 80 to 85%
  • Multiple gland hyperplasia 10 to 15 %.
  • Parathyroid carcinoma for about 1%
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22
Q

Causes of Familial Hyperparathyroidism

A

1) Multiple endocrine neoplasia type 1 (parathyroid, pancreas and pituitary)

2) Multiple endocrine neoplasia type 2a (parathyroid, Pheochromocytoma and thyroid medullary carcinoma)

3) Familial hypocalciuric hypercalcemia (FHH).
(Characterized by hypocalciuria, mild PTH elevation and mild hypercalcemia)

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23
Q

3ry Hyperparathyroidism

A

This occurs following secondary hyperparathyroidism in case of CRF due to prolonged PTH stimulation leading to → development of autonomous adenoma.

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24
Q

CP of Hyperparathyroidism

A
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25
Most Common Clinical Presentation of **Hyperparathyroidism**
The most common clinical presentation of primary hyperparathyroidism (PHPT) is asymptomatic hypercalcemia detected by routine biochemical screening.
26
Symptoms of Symptomatic **Hyperparathyroidism**
27
Renal Manifestations of **Hyperparathyroidism**
- polyuria, polydipsia, nephrolithiasis, nephrocalcinosis, Nephrogenic diabetes insipidus and renal tubular acidosis.
28
Neuropsychiatric Manifestations of **Hyperparathyroidism**
Lack of concentration, confusion, stupor and coma.
29
GIT Symptoms in **Hyperparathyroidism**
anorexia, nausea, vomiting, peptic ulcer, pancreatitis and constipation
30
MSK Symptoms in **Hyperparathyroidism**
Muscle weakness, bone pain, osteoporosis and osteitis fibrosa cystica.
31
CVS Manifestations in **Hyperparathyroidism**
Hypertension, bradycardia and shortened QT interval.
32
Dx of **Hyperparathyroidism**
33
Labs in **Hyperparathyroidism**
 Elevated PTH  Hypercalcemia  Hypophosphatemia
34
Rads in **Hyperparathyroidism**
 Detection of adenoma in isotopic scanning of parathyroid gland  Detection of osteitis fibrosa cystic, osteoporosis, kidney stones or nephrocalcinosis in X-ray.
34
Others in Dx of **Hyperparathyroidism**
Other hormonal assay if MEN is suspected
35
DDx of **Hyperparathyroidism**
36
Clinical findings that favor the diagnosis of primary hyperparathyroidism
 an asymptomatic patient with chronic mild hypercalcemia  a postmenopausal woman  a normal physical examination  no other obvious cause of hypercalcemia (such as sarcoidosis)  no family history of hyperparathyroidism  no evidence of multiple endocrine neoplasia
37
Secondary hyperparathyroidism is characterized by .....
Elevated plasma PTH, hypocalcemia and hyperphosphatemia in patients with chronic renal failure.
38
TTT of **Hyperparathyroidism**
1) Lowering of serum calcium: (see treatment of hypercalcemia). 2) Treatment of the cause: (surgical removal of adenoma in primary hyperparathyroidism, tertiary hyperparathyroidism and MEN).
39
Def of ****Hypercalcemia****
- Hypercalcemia is a relatively common clinical problem, It results when the entry of calcium into the circulation exceeds the excretion of calcium into the urine or deposition in bone
40
Causes of **HyperCalcemia**
- Increase bone resorption - Increase calcium absorption ---------- - PTH-mediated hypercalcemia - PTH-independent hypercalcemia
41
**HyperCalcemia** Due to Increased Bone Resorption
42
**Hypercalcemia** Due to Increased Ca Absorbtion
43
**Hypercalcemia** Due to PTH
44
**Hypercalcemia** Not Due to PTH
45
Chronic Granulomatous diseases Causing Hypercalcemia
TB or Sarcoidosis
46
Medications Causing Hypercalcemia
47
Miscellaneous Causes of Hypercalcemia
48
CP of Mild Hypercalcemia
Nonspecific symptoms, such as constipation, fatigue, and depression
49
CP of Moderate Hypercalcemia
Marked symptoms, including polyuria, polydipsia, dehydration, anorexia, nausea, muscle weakness
50
CP of Severe Hypercalcemia
Calcium >14 mg/dL, there is often progression of these symptoms.
51
Serum calcium should be corrected for ......, and an elevated concentration should be confirmed by repeat sampling.
albumin
52
- Additional laboratory data (including ...... for possible multiple myeloma, TSH) will often lead to the correct diagnosis. - Also, urinary calcium excretion may be helpful in certain cases as .....
serum protein electrophoresis, FHH
53
Evidence of osteitis fibrosa on bone films is very specific for .....
primary hyperparathyroidism
54
TTT of Mild Hypercalcemia
- Adequate hydration (at least 1.5-2.0 liters of water per day) is recommended to minimize the risk of nephrolithiasis. - Additional therapy depends mostly upon the cause of the hypercalcemia.
55
TTT of Moderate Hypercalcemia
- Acute rise of serum calcium requires more aggressive therapy as described for severe hypercalcemia
56
TTT of Severe Hypercalcemia
57
TTT of Severe Hypercalcemia - Volume Expansion
- Volume expansion with isotonic saline at an initial rate of 200 to 300 mL/h that then adjusted to maintain the urine output at 100 to 150 ml/h.
58
TTT of Severe Hypercalcemia - Calcitonin
- Calcitonin (4 international units/kg) and repeat measurement of serum calcium in several hours.
59
TTT of Severe Hypercalcemia - Bisphosphonates
Bisphosphonate is indicated for - Longer term control of hypercalcemia in patients with more severe (calcium >14 mg/dL) - Symptomatic hypercalcemia due to excessive bone resorption.
60
TTT of Severe Hypercalcemia - Glucocorticoides
- Glucocorticoids are effective in treating hypercalcemia due to some lymphomas, sarcoidosis, or other granulomatous diseases
61
TTT of Severe Hypercalcemia - Dialysis
- Dialysis is generally reserved for those with severe life threatening non responding hypercalcemia.
62
Done
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Y3R5: Medicine I 🩺 (47 decks)

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