Following an episode of renal colic tests come back normal except a high calcium level (22.65)
In regards to this result, what additional tests are important to determine a possible cause ?
~ serum albumin tt
Joram phosphate
- PTH levels,
-VitD
- Alk Phos
- URE
~ bone scan.
=> other: CT thorax/abdomen, CXR
What other symptoms might have this paticut also experienced ?
- fatigue, depression, mental confusion, hypotonia, seizures f2
~ anorexia, nausea, constipation we)
= Tenal stones, polyuria wed
+ cardiac abnormalities (short QT, arrhthymias) wll
bone pain, fractures. (osteitis fibroea cystica) n
~ pancreatitis Al
What are the posible causes of hypercalsaenia
(parathyroid adenoma, MEN Vl, renal failure, Vit D defen) RD
“(@ PTHGP - lung/kidney/SCC
». osteolytic bone mets - myeloma, breast, lung)
’s with fractures and patient resting
“este ulcer with increased milk consumption (milk alkali syndrome)
idosis
~ Vit D excess (exogenous)
~ other: Willam’s syndrome, familial hypocaemia (mutant Ca+ sensory receptors)
90% of patients with hypercalcaemia have either hyperPTH or other conditions as the cause.
‘How can the twa he distinguished by blood tests
hyper PTH: high PTH, high Ca‘, low phosphate, high Vit D. wll
Tother: low PTH. High igh Cat, high phosphate, low Vit D A
What are the causes of hyperparathyroidism ?
~ parathyroid adenoma (may be ectopic)
~ multiple endoctine neoplasia I/II
~ zenal failure
- Vitamin D deficiency (high PTH due to low Ca+)
How should a patient with hyperparathyroidism be managed ?
+ adequate,hydration Al
= attempt to decrease bone turnover: biphosphonates well
itonin A
= surgical removal wll
(Fecurrent stones, impaired renal function, low bone mass, Cat > 4, age < SOyr)
wed D4