kevinjoymandhra@gmail.

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Endocrine
222
System

space Active

25

velopingpatient A tetany'
Latent a bronchospasm lead Acute Clinical
Tetany
DApparent
tetany : HypocalcenmiaNormal
Hypercalcemia
Adjusted
Trousseau'
Systolic when
pressure i s face
muscde when
Chvostek's "
Carpopedol Paresthesia
Circumoral
spasms.muscle General
Tuitching to
presentation
V.iM. iL i. are tapped dangerous serum Ca
xtensiontheat e features
c-clonic with AdductionAexionAexion
Etension close Ca
cuf seen twtching HYPOCALCEMIA
to sign
acute Patique levels :
sign/main paresthesia in Adjusted Adjusted
at at is if the on has and the
of ofmcp the inlated there th e complications
Neuromuscular of = levels
uypocalcemic angle muscles.
numbness. and hypocacemia 8
seizure the thjoints.
e wrists. facial poor and +serum
interphalangeal elbow. de is muscle 0.8
serum 8.o :
Angers. to
hypocalcemia sensitivity
of cramping
accoucheur and (4 to
at I0-I5 the nerve -S. calcurn I03
any peripheral weakness. calciurn
presentation mmH mandible, on inritablity albumin). rno/dL
point the and
Laryngospasm
above sign: masseter 2 s
8Amg/d.
of joints.
Trousseau's sign speciBcty 10Anma/ d.
(adjusted
ca).
time. is twitches tinging
the which
at
a nomal
of and can 00:02:25
risk
of
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manitestotons
CVS : CNS Cataract.
Ocular Presentation
"Dermatological
manifestations: : : Chronic c:
heart prolongation.QT
Congestive
failure.
Dycarythmias
Hypotension cerebri. GTCS.Atered
calcihcations.
Cerebral
pseudotumor
Popilledema, emotional
Long
hypocalcemia !
mental QT
disturbances: mimics
Dry interval
stotus,
calcitcations.
skin, Benign
brittle qarnglia
Basal
SS
(>
com 1a
iritability intracranial smal
0 coarse
nails
and boxes/oA8
depression. hupertension
0
sec).
hair.
(BIH.

Hypocalcernia25

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223
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Endocrine
224

System

eoeds eANY

25
Evaluation
Other
3.
hypocalcemia
a. I.
: Also
3. a. I. Vtamino b. S. 4. check
AI: Stress and PTH). S. S. True
Hungry Cisplatin,
Intammation tubularhypophosphatemia.
e),injuryDrugscauses CHD:
Hemolyss. Tunor
Rhabdomyolysis. ysis albumin
mg" LOw High Low Ca
phosphorous.
iPTH.
Bisphosphonates, Hyperphosphatemia
phosphorous.
phosphorous. 3° a correctible
Hypomagnesemiacauseof for
HyPoparathyroidism of
et
bone causing of hyperparatthyroidism to evels the
hyperparathyroidism the levels. low
0
SS
huypocalcemia delciency
syndrome. Acutehypocalcemia
: cells (mg Pollowing calcium
Check
levels
iPTH
hypocalcemia causes LowCa" S.
"
pancreatitis.citrate Hypocalcemia,
/rickets i to
w Aminogjycosides,
Amphotericin i hypocalcemia. hupocalcemia. the is evaluate
(chelates reversible
hypoparothyroidism
Pseudo
6.0 Any i - most
22
"
rug High LOwhuperphosphatemia): the iPHiTH.gh High
ghosphorous. LowCa*
common
Ca). Ca*, ca", impairment cause
causing
high high reversible of
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Aoquired hypoparatthyroidism hypoparathyroidism

InheritedTypes: glarnd. Teg9with True
:parathyroid
Diagnosed
5ca833bd51680704354¬7768
TupeiHypocalcemia.
tupePEA i hypoplasia.
8letThymic
palate. 1 a 4. 3.syndrome:
DiGeorge
a.
Hypoparathyroidsm 4. recessive.
Autosomal
3. a L AbnormaCardiac
(mnemonic 3aaq t
and Autoimmune
is
Addison'
disease.
sminor Polyendocrinopathy
hypoparathyroidism Dystrophies).
ectodermal
manitestations Autoimmune with Seen and an
Polyglandular
Autoinmune microdeletion
abnormalities 4" AD
manitestations in Yacies disorder
adults endodermal
CATCH : Sestamibi
Polyendocrine Clet :
Graves :
due sundrome, seen
Postoperative : aa).
scan
to TOF. : defect.
polote. pharyngeal
pouch
: detect in
TIdisease children.
Decreased :
Dm, sundrome TeXI
hypogonadism, in type
me and APECEDsundrome gene
cause). Type defect. uptake
Candidiasis qene 00:18:13
D. by
D/APs the
Hypocalcemia25
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225
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neny-caffey
microcephaly
APECED parathyrodismhypomagnesemia,
HOR oiceorge,
CATCHaa parathyroidismsolatedFamilial Syndrome
wil timesyndrome
Hungry
bone iPTH.
PostHungry
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op Sanjad-sakatimertai
retardation,
" hupo
start
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phosphorous. High ca,LOw
hypoparathyroidism: bone None

Neet
taking ellect ALP Addison osteosclerosis
mucocutaneous
candidiasis, Chronic grouth
Poikure deafness,
kidney
Hypoparathyroidism
faratthyroid
anomalies aplasia
thymic
palate
clet Cardiac
abnormal
facies Hupocalcemnia,
hupercalciuria clnical
Other

because vs features
SS bone), for post-op disease
anomalies
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Ca* atersevere
v1.0
formation. hypoparathyroidism:
PTH Imnune
tolerance development Delecte
and third
pouch fourth
developmentbranchial Calcium
sensing synthesismutation
aRfecting Parathyroid
ts qenePTH development qland afected
Process

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rom the
hyperparathyroidism in
low
the PTH
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removed, transeriptional
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bone long a is a40300 a44460a41410 J4ca55 18400 30T100 14oa00 No.

Page5/8
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Prolonged well.as
CAme Complete
PHP : sensedsubunit
typeiTypes: Gs in when GNAS Low (PHP)
coupled
Pseudohypoparathyroidism iPTH.
" " LOW " Ca".
Low "
PHP gene Caat, Inereased
phosphorous.Low
mutation Pseudo
Associated
All Gs by
receptor),
PTH
the Type
subunit PTHresistance aderyy binds
mutation, high Adiusted serum Ca leves (no/d)
Hypoparathyroidism
(PPHP):
Pseudo
bone infusion detciencu,
Neet
rom with
lai tophosphorus, Nomal
ALP
mineral deiciency leads the 0ed 2
orate
perioperative
Calciumlevels.
SS paternal
to cyclase Gsa Aarathyroidectomy
aPter
Cays
senum
B5-0.mg'dNermal
eatonin
bone has PTH toPTH
senum
cine
AL hyperparathyroidism and
changes mineral no t PTH the subunit serum
iPhiTH.gh
levels Ca

(PTH receptor of
leveks. elcptonin
treatmernt ALP
v1.0 side, in effectresistance binding
increase Gmg/d)
Calcum - uyear
a
Me
parathyrodeetomy variations
blood resistance).
" but changes.
o
detciency, old
male ntravenous
6-sa/dap
maanesum
(a-a/da)
nfutlon calelum
ard
of
on to in(an
rrow plemertaton

normal. Type
GNASla, primarsduring
68-430
biochemically S. to sth

6.0" Ca/phosphorous other PTH adenylyl

cAmp /L
oral
eaerol

2022 receptornot is -sun

hormones levels. S00
S00 ao00 asoo 8O00
s00 4000

cyclase da
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Hypocalcemia25
Active space

227
 System

space Active

changes/AHO:
mineral
Sone
PHP a PHP I8PPHP PHP IA NoPartial
urinay
Type TypePHPa: CAHO). eone
Osteodystrophy
eect
mentaltacies.
retardation).
calcitcation.
Heterotopic Round
me
Archibald stature.
Short mineral Not No TupePHPIb:
Short Yes Yest Yes No resistance
cAMP
Neet
5ca833bd51680704Rb77Rhhyperphosphatemiaof urinary
Hypocalcemia, on associated Gsa
4t Classilcation S. changes subunit
SS metacarpal
sign Ca/phosphorous wil
Medicine increase onluy
(dimple
Normal NormalReduced
to inwitth
deciency
v1.0
"
PTH
Response
CAMe to
PTH. PHP
lbrachydactyly:on of in any
PHP response is
Marrow 4" Hiah Normal High Serum
knoun bone
metacarpa). PTH
and levels. in
.0"2022
mineral blood.
YesNo Yes No
oelcencySubunit PpHP to as
PTH Albrights
Yes Yes AHO infusion. changes.
No someYesin
patients) Yes
hormone to
Resistance
other
than
Hereditary
PTH

age7/8
Feedback

" "
gven, hourintusion ghypocalcemia
OralTheretore, IgTreatment of
Acute Knucke Short
Krvckle Clenched
contains 00
calcim mg/hour).(ao severe
m inuckle
hnuckle
Dimple 4tth
Knuctesundrome
Turner's
uwhich : metacarpal
Ast Normal
480
5gin of Knuckle
up is 98 or
Calcium Dimple has

to las mg s00symptomatic.
ma Kinuckle
bone. Hnuckle
Knuckles
al

m/hour
ag of of
guconate
Knuckle
dinmple
signs
daily calciun elemental mi
5D Knuckle Knuckle
sign
or at 4"h
30 in I-3
mg IO
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drops/minute. 50O calcium. %
Knuckle hnuckle
4tsh
h Short DrpleKnucklesundrome
Hruckle
Knuckle Short3rd
ooun's
Pseudohypoparatthyroidism
type ia
ml of over 4h
Dimple
metacarpal
overelemental io
inuckle hnuckle and
sh
4
mins nuckle
Dimple metacarpal
Dimple
hours bone
calcium/ka (rule Kruckle
Dimple Dimple Yruckle
to of bones
00:44:02 sign
be Io). sion
3rd
Hypocalcemia25
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229
 Hypocalcemia- Diagnostic algorithm
HYPOCALCEMIA
MARROV
SS Medicin

Creatinine level
[email protected]

Normal High
Renal failure
Secondary
hyperparathyroidism
PTH

Low High

Hypoparsthyroidism 25(0H)D level

Acquired:
Postsurgical
Postradiation
Hypomagnesemia Low Normal
infiltrative/autoimmune diseases
of parathyroid gland
Genetic causes

1,25(0H)2D levet
VitaminD dencioncy
Inadequate intake
Low sun exposure
Malabsorption
Malnutrition Normal High
Nephrotic syndrome
Hopatobiliary disoases
Medications

Psoudohypoparathyroidism:
Type lab, Type I Vitamin D-resistant rickets
Vitamin D-dependent rickets

PIH - parathyroid hormone

 Calcium suppression test
lonized calcium

Normal Low
No action
True hypocalcemia

Serum magnesium

Normal Low
Determine cause
Replace magnesium
Serum phosphorus

High Low

PTH Calcidiol, calcitriol

High Low
Pseudohypoparathyroidism Hypoparathyroidism
Tumor lysis syndrome
Renal failure

Calcidiol low Calcidiolnormal Calcitriol high

Calcitriol low
Nutritional Type llvitamin D
malabsorption Type Ivitamin D dependent rickets
drugs dependent rickets
Renal failure