Clinical manifestations-hypercalcemia

(“bones, stones, abdominal groans, and psychic moans”)

Primary hyperparathyroidism

• Hypercalcemic crisis (usually when Ca >13–15): polyuria, dehydration, ΔMS

  • 高鈣血症危象（通常在 Ca >13-15 時）：多尿、脫水、昏掉

• Ca toxic to renal tubules → blocks ADH activity, causes vasoconstriction and ↓ GFR → polyuria but Ca reabsorption → ↑ serum Ca → ↑ nephrotoxicity and CNS sx

  • Ca 對腎小管有毒 → 阻斷 ADH 活性，導致血管收縮和 ↓ GFR → 多尿但 Ca 重吸收 → ↑ 血清 Ca → ↑ 腎毒性和 CNS sx

• Osteopenia, fractures, and osteitis fibrosa cystica (latter seen in severe hyperpara. only → ↑ osteoclast activity → cysts, fibrous nodules, salt & pepper appearance on X-ray)

  • 骨質減少、骨折和囊性纖維性骨炎（後者僅見於嚴重的超段。僅 → ↑ 破骨細胞活動 → 囊腫、纖維結節、X 射線上的”鹽和胡椒外觀”）

• Nephrolithiasis, nephrocalcinosis, nephrogenic DI

• Abdominal pain, anorexia, nausea, vomiting, constipation, pancreatitis, PUD

  • 腹痛、厭食、噁心、嘔吐、便秘、胰腺炎、PUD

• Fatigue, weakness, depression, confusion, coma, ↓ DTRs, short QT interval

  • 疲勞、虛弱、抑鬱、意識模糊、昏迷、↓ DTR、短 QT 間期

• 1° HPT: 80% asx, 20% nephrolithiasis, osteoporosis, etc.