HYPOCALCEMIA

HYPOCALCEMIA: Excerpt from Algorithmic Diagnosis of Symptoms and Signs

Ask the Following Questions:

1. What is the PTH assay? If this is low, hypoparathyroidism ought to be considered the most likely diagnosis. If it is normal or increased, other causes of hypocalcemia should be investigated.
2. What is the phosphorus level? A decreased phosphorus level should prompt a search for malabsorption syndrome, rickets, osteomalacia, renal tubular acidosis, cirrhosis, and nephrotic syndrome. An elevated phosphorus level would be most suggestive of renal disease, but pseudohypoparathyroidism must be considered also.
3. What is the alkaline phosphatase level? This would be elevated in hypocalcemia due to malabsorption syndrome, rickets, osteomalacia, renal tubular acidosis, and other chronic renal disease. It would be normal in cirrhosis, nephrosis, alkalosis, and pseudohypoparathyroidism.

DIAGNOSTIC WORKUP

CBC, urinalysis, chemistry panel, 24-hr urine calcium, PTH assay, serum protein electrophoresis, serum 25-OH vitamin D3 , skeletal survey, bone scan, d -xylose absorption test, serum 1,25-(OH) ₂ vitamin D, and an endocrinology consult should be considered in the workup. Pseudohypoparathyroidism can be further differentiated from primary hypoparathyroidism by the Ellsworth-Howard test, which involves injecting parathyroid hormone intravenously. The blood values of calcium and phosphorus will improve in primary hypoparathyroidism but remain the same in pseudohypoparathyroidism. There is a phosphate diuresis in primary hypoparathyroidism.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

More About Hypoparathyroidism

• Back to disease: Hypoparathyroidism: Introduction
• Next Book Extract About Hypoparathyroidism: THYROID ENLARGEMENT (Algorithmic Diagnosis of Symptoms and Signs)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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