Paeds Vivas · endocrinology-diabetes-and-growth
Hypercalcaemia and hyperparathyroidism — branching viva
Branching viva from the PTH fork, through the urine calcium-to-creatinine clearance ratio that separates FHH from PHPT, the saline-first resuscitation, the calcitonin-then-bisphosphonate drug logic, the hereditary syndromes, and the hypotonic hypercalcaemic neonate.
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RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the paediatric registrar in the emergency department and the outpatient clinic. The consultant asks you to assess three children: an adolescent with stones and bone pain, a child with lifelong mild hypercalcaemia and a family history, and a hypotonic neonate with a markedly high calcium. The examiner releases information in stages.
Station opening
Examiner: "Tell me the single test that frames every child with a high serum calcium, and why it matters." [1]
Strong candidate (must-hit)
- The test is the intact parathyroid hormone, drawn with the calcium. When the calcium is high, a normal axis switches the hormone off, so a hormone that is high or inappropriately normal means the parathyroid is driving the calcium — primary hyperparathyroidism or familial hypocalciuric hypercalcaemia. A hormone that is suppressed means the calcium is coming from elsewhere — malignancy, vitamin D, bone, a drug. Holding that fork turns a long differential into two short lists and a clear plan, and it decides the next test. [1]
Weak candidate
- "I would check the vitamin D level and a bone density scan." [1]
References6ShowHide
- [1]Bilezikian JP; Khan AA; Silverberg SJ; Fuleihan GE; et al Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop J Bone Miner Res, 2022.PMID 36245251
- [2]Marcocci C; Bollerslev J; Khan AA; Shoback DM Medical management of primary hyperparathyroidism: proceedings of the fourth International Workshop on the Management of Asymptomatic Primary Hyperparathyroidism J Clin Endocrinol Metab, 2014.PMID 25162668
- [3]Kollars J; Zarroug AE; van Heerden J; Lteif A; et al Primary hyperparathyroidism in pediatric patients Pediatrics, 2005.PMID 15805373
- [4]Gorvin CM Genetic causes of neonatal and infantile hypercalcaemia Pediatr Nephrol, 2022.PMID 33990852
- [5]Pidasheva S; Canaff L; Simonds WF; Marx SJ; et al Impaired cotranslational processing of the calcium-sensing receptor due to signal peptide missense mutations in familial hypocalciuric hypercalcemia Hum Mol Genet, 2005.PMID 15879434
- [6]Hobbs A; Nair R; Ludwig K; Ambler GR; et al Denosumab as a treatment for pediatric hypercalcemia-a multicenter experience JBMR Plus, 2026.PMID 41522662