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Calcium Disorders William E. Clutter, M.D. Associate Professor of Medicine Department of Internal Medicine Division of Endocrinology, Metabolism & Lipid Research
Calcium regulation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Calcium balance ECF CALCIUM GUT KIDNEY BONE (1 kg) Net 175 mg Net 175 mg 500 mg 500 mg 1000 mg
Hypercalcemia: clinical signs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hypercalcemia: major causes ,[object Object],[object Object],[object Object]
Hyperparathyroidism: causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Malignant hypercalcemia: major causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hypercalcemia: other causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hypercalcemia: presentations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Primary hyperparathyroidism ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hypercalcemia: evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Primary hyperparathyroidism: Rx ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NIH consensus Panel JCEM 87:5353, 2002
Parathyroid Localization Sestamibi scans Left lower parathyroid adenoma Mediastinal parathyroid adenoma
Primary hyperparathyroidism: pitfalls ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Primary hyperparathyroidism: pitfalls ,[object Object],[object Object],[object Object],[object Object]
Primary Hyperparathyroidism ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Nonparathyroid hypercalcemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Severe hypercalcemia: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Severe hypercalcemia: therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hypocalcemia: clinical signs ,[object Object],[object Object],[object Object],[object Object],[object Object]
Trousseau’s sign
Hypocalcemia: causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hypocalcemia: evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hypocalcemia: evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hypocalcemia: evaluation Cause Hypoparathyroidism PTH resistance Vitamin D deficiency Vitamin D resistance Phosphate High High Low Low Other PTH low PTH high 25-OHD low Alk phos Normal Normal High High
Hypocalcemia: acute therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hypocalcemia: chronic therapy ,[object Object],[object Object]

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Calcium disorder

  • 1. Calcium Disorders William E. Clutter, M.D. Associate Professor of Medicine Department of Internal Medicine Division of Endocrinology, Metabolism & Lipid Research
  • 2.
  • 3. Calcium balance ECF CALCIUM GUT KIDNEY BONE (1 kg) Net 175 mg Net 175 mg 500 mg 500 mg 1000 mg
  • 4.
  • 5.
  • 6.
  • 7.
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  • 11.
  • 12.
  • 13. Parathyroid Localization Sestamibi scans Left lower parathyroid adenoma Mediastinal parathyroid adenoma
  • 14.
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  • 18.
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  • 20.
  • 22.
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  • 24.
  • 25. Hypocalcemia: evaluation Cause Hypoparathyroidism PTH resistance Vitamin D deficiency Vitamin D resistance Phosphate High High Low Low Other PTH low PTH high 25-OHD low Alk phos Normal Normal High High
  • 26.
  • 27.