Moans, groans, stones, bones and psychological overtones
What's the first step to working up a possible hypercalcemia?
Check serum calcium
After checking calcium, say it's high. What is the next steP?
Check urine calcium. If it's low, then you have familial hypocalciuric hypercalcemia (your CaSR are just not sensitive and you have high calcium).
What if urine calcium is high?
Take a look at PTH. If it's high, then primary hyperparathyroidism. If it's low, check 25OHD.
Say you checked Ca(high), Urine Ca(high) and then PTH(low) and now you've check 250HD and it's high. What's your problem?
Vitamin D intoxication. You're sucking in a whole lot of phosphate and calcium.
If 25OHD was normal, what would you check next?
Check the active product -- 1,25(OH)2D3. If this is high, perhaps you have an ectopic production (RARE). If this is normal, check PTH-RP.
What is PTH-RP
PTH-related protein. If elevated, may indicate a neoplasm.
How do you calculate Ca/Cr clearance ratio?
Urinary calcium/plasma calcium x plasma creatinine/urinary creatinine.
U P? P U!
What is the chvostek sign?
Facial muscles on the same side of the face will contract momentarily when the facial nerve is tapped at the jaw because of hyperexcitability of nerves secondary to hypocalcemia.
What is the Trousseau Sign
Blood pressure cuff is placed around the arm and inflated to pressure great than systolic BP for 3 min. Carpal spasm is suggestive of hypocalcemia. Believed to be less sensitive vs. Chvostek.
What syndrome includes hypoparathyroidism (that was used in the lecture as an example?)
DiGeorge Syndrome: associated with deletions of chromosome 22q11.2; Involves development of 3rd and 4th branchial pouches. CATCH22 - Cardiac defect (aortic arch), Anomaly of the face, Thymic hypoplasia, cleft palate, hypoparathyroidism.
What is pseudohypoparathyroidism?
Autosomal dominant disorder that leads to peripheral resistance to PTH. End up with Albright Hereditary Osteodystrophy syndrome (bad bones...).
Pseudopseudohypoparathyroidism - what's up?
Describes patients with Albright osteodystrophy PHENOTYPE... but without the biochemical abnormalities
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