The approach to the management of a child presenting with Hypo or Hypercalcaemia requires an understanding of the physiological regulation of plasma calcium and the key hormones and receptors that are important components. These include Vitamin D, Parathyroid hormone (PTH), the Calcium sensing receptor and renal function. The differential diagnosis for both these conditions is wide and it is important that relevant investigations are undertaken at presentation prior to the initiation of treatment. In the assessment of Hypocalcaemia the measured PTH level at presentation will provide an important clue as to the possible underlying disorders and direct subsequent investigations. A similar approach is required in the assessment of Hypercalcaemia where the measured PTH level will categorise the condition as PTH dependent or PTH independent. The condition of the child at presentation will also influence the interpretation of the severity of the underlying disorder and the urgency of management. For example a child who is discovered to have a high plasma calcium on a blood test undertaken for other reasons who is asymptomatic may have the condition Familial Hypocalciuric Hypercalcaemia (FHH) that requires no active management. Many conditions that present in childhood with Hypo or Hypercalcaemia have a genetic basis which may have implications for other family members. It is therefore important to include genetic confirmation once the underlying diagnosis is apparent. Long term drug treatment is required for many of the conditions which will require appropriate monitoring to ensure effectiveness but also to avoid adverse effects.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology