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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