Hyper/hypo Calcemia

Front 1

What hormone controls serum calcium?

Back 1

PTH

Front 2

What are the effects of PTH?

Back 2

osteoclast release of calcium from bonel; kidney reabsorption of calcium; kidney production of a-1-hydroxylase (converts calcidiol into calcitriol > enhances gut absorption)

Front 3

Elevated serum phosphate does what to PTH?

Back 3

Stimulates release

Front 4

what does PTH do to the renal absorption of phosphate?

Back 4

Decreases it (promotes the loss of phosphate)

Front 5

When PTH derangement is the primary disorder, what is expected in the serum levels of calicum and phophate?

Back 5

recipricol releationship (caveat)

Front 6

In a situation where you have high calcium AND high phosphate, which one effects the parathyriod more?

Back 6

Calcium

Front 7

T/F Vitamin D promotes the absoption of BOTH calcium and phosphate from the gut?

Back 7

TRUE;

Front 8

What opposes PTH by promoting uptake of calcium by bone?

Back 8

Calcitonin (c-cells in the thyroid)

Front 9

What happens to serum calcium if thyroid hormones increase?

Back 9

there is osteolysis which increases calcium

Front 10

What do estrogenic and androgenic steroids do to calcium and phosphate bone deposition?

Back 10

Increase, lowering osteolysis, lowering serum calciium

Front 11

How do we correct serum calcium levels to reduced albumin?

Back 11

for every 1 gram/dl reduction in albumin, serum calcium is increased by .8 mg/dl

Front 12

If serum calcium is LOW, then PTH should be?

Back 12

HIGH

Front 13

What are some signs and symptoms of HYPERcalcemia?

Back 13

fatigue, depression, mental status change, coma, anorexia, nasuea/vomiting, constipation, short QT interval, nocturia/polyuria

Front 14

Why is there polyuria in hypercalcemia?

Back 14

Hypercalcemia induces nephrogenic diabetes insipidus (inability to sense ADH) >> marked volume depletion

Front 15

What is the most common hypercalcemia encountered in an ambulatory practice among patients who seem well?

Back 15

Primary hyperparathyroidism PHP

Front 16

What are some lab clues of PHP?

Back 16

high PTH (despite hypercalcemia); High urine calcium; high calcitriol; LOW phosphate; HIGH chloride; HIGH serum alkaline phosphate

Front 17

What are indications of parathyroidectomy in PHP?

Back 17

Any one of the major symptoms (Subperiosteal bone resorption, cystic bone disease, osteoporosis, nephrolithiasis, nephrocalcinosis) AND symptomatic or severe hypercalcemia

Front 18

What is the most common cause of PHP?

Back 18

Parathyroid adenoma

Front 19

If a patient has a strong family history of hyperparathyroidism, then what would you consider as a cause of PHP?

Back 19

parathyroid hyperplasia (MEN 1 and MEN 2)

Front 20

MEN 1 is?

Back 20

Pituitary adenoma, pancreatic islet cell tumor, parathyroid hyperplasia

Front 21

MEN 2 is?

Back 21

Pheochromocytoma, medullary thyroid carcinoma, parathyroid hyperplasia

Front 22

What is the most common eitiology of hypercalcemia in patients among hospital inpatients?

Back 22

Malignancy related (ill appearing, symptomatic, known malignancy)

Front 23

What are some malignant mechanisms for hypercalcemia?

Back 23

bone metastis, osteolytic cytokines, more Vit D3, PTH-like (squamous cell carcinoma)

Front 24

What are the lab findings of Malignancy related hypercalcemia?

Back 24

LOW PTH; high ca, LOW phosphate, Azotemia, HIGH urine calcium,

Front 25

What is the most common form of granulamatous disease causing hypercalcemia?

Back 25

Sarcoidosis (fungal, TB, berylliosis also)

Front 26

What is the mechanism of hypercalcemia due to granulomatous disease?

Back 26

more VD3, increased GUT absorption of both Calcium (which suppresses PTH) and phosphate > no PTH > High phosphate and Calcium

Front 27

What is an excellent therapy for hypecalcemia due to sarcoidosis?

Back 27

Glucocorticoids

Front 28

What is the best clue in diagnosing hypercalcemia due to Vitamin D intoxication?

Back 28

identifying prescription or over the counter Vitamin D containing products ; Checking for CALCIDIOL (will be HIGH)

Front 29

Low PTH, HIGH Phosphat, HIGH Calcium, HIGH CALCIDIOL?

Back 29

Vitamin D intoxication

Front 30

Low PTH, HIGH Phosphat, HIGH Calcium, HIGH CALCITRIOL?

Back 30

Granulomatous Disease

Front 31

Hypercalcemia, hypocalciuria (low urine calcium); hypermagnesemia?

Back 31

FHH (familial hypocalciuric hypercalcemia)

Front 32

Are patients with FHH in need of parathyroidectomy?

Back 32

NO

Front 33

High-normal or slightly high PTH, normal phosphate, High calcium, VERY LOW urine calcium?

Back 33

Familial hypocalciuric hypercalcemia

Front 34

What is the treatment of hypercalcemia?

Back 34

Correct volume depletion, parathyroidectomy (if needed); Drugs (bisphosphonates; calcitonin; glucocorticoids)

Front 35

What is the drug of choice for malignancy related hypercalcemia?

Back 35

Bisphosphonate

Front 36

What is the only effective treatment for hypercalcemia caused by Vitamin D intoxication, granulomatous disease, and hematological malignancy related hypercalcemia?

Back 36

Glucocorticoid

Front 37

What is a common cause of low calcium and increased PTH?

Back 37

Renal insufficiency

Front 38

What is the differential for low calcium, high phosphate in the serum?

Back 38

Renal disease (usually end-stage); PTH production problem; PTH action problem

Front 39

What are the sings and symptoms of hypocalcemia?

Back 39

Acral/perioral paresthesias; Carpopedal spasm; laryngospasm; Seizure; mood disorder/irratibility; Increased intracranial pressure; Prolonged QT time; Cardiac arrhythmias

Front 40

What two signs, if are positive can indicate hypocalcemia?

Back 40

Chvotek's (facial nerve); Trousseau (BP cuff > Carpal spasms

Front 41

What are the differentials for hypocalcemia due to ABSENT PTH?

Back 41

hypoparathyroidism (aquired, congenital, autoimmune, hypomagnesemia)

Front 42

What are the differentials for hypocalcemia due to PTH resistance?

Back 42

PTH resistance (pseudohypoparathyroidism; hypomagnesemia)

Front 43

What are the Vitamin D related causes of hypocalcemia?

Back 43

Deficiency (diet, sun, malabsorption); Impaired activation (liver, renal); Resistance (Rickets)

Front 44

What is critical to the production and release of PTH?

Back 44

magnesium (hypomagnesemia can lead to functionla hypoparathyroidism)

Front 45

What are some post-op hypocalcemias that can occur?

Back 45

removal of parathyroid; hypomagnesemia; Suppresion of remaining parathyroid glands due to hypercalcemia

Front 46

What is " hungry bone syndrome" and how can it be diagnosed?

Back 46

long standing hypercalcemia > then removal of parathyroid > bone resorb calcium > remaining parathyroids suppressed > low calcium and low phosphate

Front 47

What is the emergent treatment of symptomatic hypocalcemia?

Back 47

one ampule calcium gluconate IV, + 8-10 ampules of Calcium gluconate in one liter over 6-10 hours