L16: Hypocalcemia & Hypoparathyroidism

Question 1

Def of Hypocalcemia

Answer 1

Serum calcium level below the reference range, (Which is 8.5-10.5)

Question 2

Causes of Hypocalcemia

Answer 2

• PTH Related (Low - High)
• PTH Non-Related
• Drugs

Question 3

Causes of Hypocalcemia D2 Low PTH

Answer 3

• Congenital
• Acquired

Question 4

Causes of Hypocalcemia D2 Low PTH

• Congenital

Answer 4

Question 5

Causes of Hypocalcemia D2 Low PTH

• Acquired

Answer 5

Question 6

Causes of Hypocalcemia D2 High PTH

Answer 6

Question 7

Parathyroid hormone resistance

Answer 7

Question 8

Causes of Hypocalcemia Independent on PTH

Answer 8

Question 9

Drugs inducing hypocalcemia

Answer 9

Question 10

CP of Hypocalcemia

Answer 10

• Acute & Chronic Manifestations

Question 11

Pathophysiology of acute manifestations of Hypocalcemia

Answer 11

Increase peripheral neuromuscular irritability

Question 12

When do Manifestations of Latent tetany appear?

Answer 12

Serum calcium:
- 7.5-8 mg / dl.

Question 13

Manifestations of Latent tetany

Answer 13

Question 14

Chvostek’s sign

Answer 14

Facial sign tapping on facial nerve in front of ear twitches of facial muscles.

Question 15

Peroneal sign

Answer 15

tapping on peroneal nerve at the neck of fibula contraction of peroneal muscle

Question 16

Trousseau’s sign

Answer 16

Elevation of blood pressure on the brachial artery above systolic for 3 – 5 minute → carpal spasm

Question 17

Erb’s sign

Answer 17

• Current less than 4 Milli amperes produce muscular Contraction.
• Normally, at least 8 Milli ampere required

Question 18

When does Manifest tetany appear?

Answer 18

7 – 7.5 mg / dl

Question 19

Manifestations of Manifest tetany

Answer 19

• Pain & paresthesia
• Carpo-pedal spasm
• Other muscular spasm
• Convulsion and generalized seizures

Question 20

Pain & paresthesia in Manifest tetany

Answer 20

in the extremities & around mouth

Question 21

Carpo – pedal spasm in Manifest Tetany

Answer 21

Question 22

Other muscular spasm in Manifest Tetany

Answer 22

 Blepharospasm → spasm of eye lid muscles.
 Rhisus sardonicus → spasm of facial muscles.
 Trismus of Jaw → spasm of mastication muscles.
 Laryngismus stridulus → laryngeal muscle spasm.
 Opisthotonus position → spasm of back Ms.
 Spasm of GIT ms → colic.

Question 23

Blepharospasm

Answer 23

 Blepharospasm → spasm of eye lid muscles.

Question 24

Rhisus sardonicus

Answer 24

 Rhisus sardonicus → spasm of facial muscles.

Question 25

Trismus of Jaw

Answer 25

 Trismus of Jaw → spasm of mastication muscles.

Question 26

Laryngismus stridulus

Answer 26

 Laryngismus stridulus → laryngeal muscle spasm.

Question 27

Opisthotonus position

Answer 27

 Opisthotonus position → spasm of back Ms.

Question 28

Spasm of GIT ms

Answer 28

Spasm of GIT ms → colic.

Question 29

Convulsion and generalized seizure in Manifest Tetany

Answer 29

In severe hypocalcemia

Question 30

Chronic manifestations of hypocalcemia

Answer 30

Question 31

Chronic manifestations of hypocalcemia - Extrapyramidal Disorders

Answer 31

 Basal ganglia calcifications  Leads to parkinsonism, other movement disorders  Some cases only improve with TTT.

Question 32

Chronic manifestations of hypocalcemia - Occular Disease

Answer 32

Catarct

Question 33

Chronic manifestations of hypocalcemia - Dental

Answer 33

Dental hypoplasia, failure of tooth eruption, and carious teeth.

Question 34

Chronic manifestations of hypocalcemia - skeletal

Answer 34

Osteosclerosis, cortical thickening, and craniofacial abnormalities

Question 35

Chronic manifestations of hypocalcemia - Ectodermal

Answer 35

 Skin: dry, coarse.  Nail: brittle.  Hair: loss.

Question 36

Vitamin D deficiency

Answer 36

- Can cause hypocalcemia - If severe, lead to rickets and osteomalacia.

Question 37

INVx for hypocalcemia - Investigate for Cause

Answer 37

Question 38

INVx for hypocalcemia - Confirm the Dx

Answer 38

Question 38

INVx for hypocalcemia

Answer 38

- To Confirm Dx - To Identify Cause - To Identify Complications

Question 39

INVx for hypocalcemia - Investigate for complications

Answer 39

Question 40

TTT of Hypocalcemia

Answer 40

- during Attack - TTT of Cause

Question 41

TTT of Hypocalcemia - During Attack

Answer 41

 1 to 2 g of calcium gluconate can be infused over 10 to 20 minutes.  Can be repeated.

Question 42

TTT of Hypocalcemia - TTT of Cause

Answer 42

Question 43

TTT of Hypocalcemia - TTT of Cause (decreased PTH)

Answer 43

lifelong calcium and active vitamin D supplementation (calcitriol)

Question 44

TTT of Hypocalcemia - TTT of Cause (Decreased Vit D)

Answer 44

Question 45

TTT of Hypocalcemia - TTT of Cause (CKD)

Answer 45

Phosphate binder, calcium and active vitamin D supplementation (calcitriol).

Question 46

Nature of PHP (In terms of Genetics)

Answer 46

A.D disease

Question 47

Pathology in PHP

Answer 47

End Organ Resistant “No PTH receptors in kidney and bone ".

Question 48

Characters of PHP (Labs)

Answer 48

PTH resistance is characterized by  Hypocalcaemia  Hyperphosphatemia  Elevated PTH concentrations

Question 49

Types of PHP

Answer 49

1 & 2

Question 50

Etiology of PHP type 1

Answer 50

 Caused by mutation of GNAS gene coding the alpha subunit of the G protein, which coupled to the PTH receptor  Leads to inability to activate adenyl cyclase

Question 51

Types of PHP type 1

Answer 51

A, B & C

Question 52

PHP Type 1A

Answer 52

Question 53

PHP Type 1B

Answer 53

Question 54

PHP Type 1C

Answer 54

Question 55

PHP Type 2 - Nature (Genitically)

Answer 55

AD

Question 56

PHP Type 2 - CP

Answer 56

 All hypo calcemic manifestations  No features of AHO.

Question 57

PHP Type 2 - Defect

Answer 57

Not Detected

Question 58

TTT of PHP

Answer 58

 As Hypoparathyroidism  Lifelong calcium and active vitamin D

Question 59

PPHP

Answer 59