TAILIEUCHUNG - Chapter 047. Hypercalcemia and Hypocalcemia (Part 3)

A detailed history may provide important clues regarding the etiology of the hypercalcemia (Table 47-1). Chronic hypercalcemia is most commonly caused by primary hyperparathyroidism, as opposed to the second most common etiology of hypercalcemia, an underlying malignancy. The history should include medication use, previous neck surgery, and systemic symptoms suggestive of sarcoidosis or lymphoma. Once true hypercalcemia is established, the second most important laboratory test in the diagnostic evaluation is a PTH level using a two-site assay for the intact hormone. Increases in PTH are often accompanied by hypophosphatemia. In addition, serum creatinine should be measured to assess renal function; hypercalcemia. | Chapter 047. Hypercalcemia and Hypocalcemia Part 3 A detailed history may provide important clues regarding the etiology of the hypercalcemia Table 47-1 . Chronic hypercalcemia is most commonly caused by primary hyperparathyroidism as opposed to the second most common etiology of hypercalcemia an underlying malignancy. The history should include medication use previous neck surgery and systemic symptoms suggestive of sarcoidosis or lymphoma. Once true hypercalcemia is established the second most important laboratory test in the diagnostic evaluation is a PTH level using a two-site assay for the intact hormone. Increases in PTH are often accompanied by hypophosphatemia. In addition serum creatinine should be measured to assess renal function hypercalcemia may impair renal function and renal clearance of PTH may be altered depending on the fragments detected by the assay. If the PTH level is increased or inappropriately normal in the setting of an elevated calcium and low phosphorus the diagnosis is almost always primary hyperparathyroidism. Since individuals with familial hypocalciuric hypercalcemia FHH may also present with mildly elevated PTH levels and hypercalcemia this diagnosis should be considered and excluded because parathyroid surgery is ineffective in this condition. A calcium creatinine clearance ratio calculated as urine calcium serum calcium divided by urine creatinine serum creatinine of is suggestive of FHH particularly when there is a family history of mild asymptomatic hypercalcemia. Ectopic PTH secretion is extremely rare. A suppressed PTH level in the face of hypercalcemia is consistent with non-parathyroid-mediated hypercalcemia most often due to underlying malignancy. Although a tumor that causes hypercalcemia is generally overt a PTHrP level may be needed to establish the diagnosis of hypercalcemia of malignancy. Serum 1 25 OH 2D levels are increased in granulomatous disorders and clinical evaluation in combination with laboratory testing

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