ABC Medical Notes.com |
|
---|---|
Free Open Access Medical Information | |
MEDICAL DISCLAIMER:The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd |
Related Subjects: |Familial hypocalciuric hypercalcaemia (FHH) | Primary Hyperparathyroidism |Lung Cancer | Hypercalcaemia | Multiple Myeloma | Oncological emergencies | Bisphosphonates
An albumin adjusted serum calcium of over 2.6 mmol/L (UK). More than 90% of cases are due to malignancy or primary hyperparathyroidism
Initial Hypercalcaemia Management Summary |
---|
|
Causes | Details |
---|---|
Primary hyperparathyroidism | Elevated PTH. Calcium mild to moderately high. Often an otherwise well patient. Symptoms minimal. |
Malignancy | Due to osteolytic bone metastases (lung, breast and myeloma) or PTH-related peptide PTH-rp (squamous cell lung) or Osteoclast activating factors (myeloma, lymphoma). Often unwell. Weight loss and other systemic malignancy signs//symptoms. Needs CXR. Moderate to severe hypercalcaemia |
Myeloma | Check ESR, FBC, PPE, BJP bone pain, fractures, anaemia, renal failure (not MGUS by definition) |
Sarcoidosis | ↑ ectopic 1,25 (OH)2 D seen with many granulomatous diseases |
Drugs | Thiazides (Urine calcium is low), Vitamin D and Vitamin A, Lithium |
Endocrine | Addison's disease, Hyperthyroid, Phaeochromocytoma, Acromegaly, VIPomas |
MEN I / II | Autosomal dominant |
Familial hypercalcaemic hypocalciuria | Autosomal dominant with increased PTH - It is important to identify patients with Familial hypocalciuric hypercalcaemia to prevent a wrong diagnosis of primary hyperparathyroidism and unnecessary diagnosis of parathyroidectomy as the operation does not cure the raised calcium. The urine calcium is inappropriately low. |
Milk-alkali syndrome | Was seen with milk + excess antacids. Urine calcium lower than expected. |
Paget's disease | Immobilisation |
Tertiary hyperparathyroidism | Secondary hyperparathyroidism which has become autonomous. Usually seen in those with chronic kidney disease |