Organigram

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PHYSIOTHERAPIST

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Elevated Calcium

Treatments and Complications

Bisphosphonates to increase bone mineral density if low

Unwanted Side Effects

Atypical fractures

Osteonecrosis of the jaw

Arthalagias/myaligias/bone pain

Infusion reactions

GI side effects: esophagitis and esophageal ulcers

If labs show primary hyperparathyroidism then do a subtotal parathyroidectomy because the calcium is > 11.0 and the patient is experiencing symptoms such as constipation and hypertension.

Complications

chronic hypocalcemia requiring life long calcium and vitamin D supplementation

Injury to recurrent laryngeal nerves

Classic findings on Physical Exam

Decreased Deept Tendon Reflexes

Abdominal Pain

Palpitation

Proximal weakness

Hypertension

History

Have you been feeling any fatigue or symptoms of depression?

Have you been experiencing any fevers or unexplained weight loss?

Have you been experiencing any stomach pain or burning after eating?

Have you been experiencing muscle pain on weakness?

Has anyone in your family experienced similar symptoms?

Are you taking any of the following medications such as lithium, vitamin D, antacids, or thiazide diuretics?

Differential diagnosis

Multiple Endocrine Neoplasia

Adrenal insuffiency

Drugs: thiazide diuretics, lithium, vitamin D intoxication

Granulomatous disease

Hypercalemia of malignancy

Primary hyperparthyroidism

Recheck Serum Calcium

Calcium elevated

EKG

Tall, peaked T waves, short QT interval, possible p wave disappearance, heart block, bradyarrythmias

X-ray

May show fragility fracture

May show decreased bone density

DEXA Scan

May show osteoporosi

KUB

May show kidney stones

Check 24 hr urine

Will show hypercalciuria

Check phosphate levels

Phosphate levels low

Check PTH

PTH low or low normal

Check PTHrP

PTHrP normal

Consider other causes: medications such as Lithium, Vitamin D, Antacids, Thiazide diuretics, Granulomatous disease: Sarcoidosis, TB, Hyperthyroidism

PTHrP elevated

Hypercalcemia of malignancy likely proceed with cancer workoup: PET-scan, MRI with and without contrast to locate tumor.

PTH elevated

Primary hyperparathyroidism. Screen for MEN syndrome if < 30

high resolution neck ultrasound

Pre-op sestamibi-iodine subtraction scanning to locate adenoma