Hypercalcemia

Overview

Hypercalcemia is a disorder in which there is too much calcium in the blood.

What are the symptoms of Hypercalcemia?

Abdominal symptoms:

  • Constipation
  • Nausea
  • Pain
  • Poor appetite
  • Vomiting

Kidney symptoms:

  • Flank pain
  • Frequent thirst
  • Frequent urination

Muscle symptoms:

  • Muscle twitches
  • Weakness

Psychological symptoms:

  • Apathy
  • Dementia
  • Depression
  • Irritability
  • Memory loss

Skeletal symptoms:

  • Bone pain
  • Bowing of the shoulders
  • Fractures due to disease (pathological fractures)
  • Loss of height
  • Spinal column curvature

What causes Hypercalcemia?

Primary hyperparathyroidism is the most common cause of hypercalcemia. It is due to excess PTH release by the parathyroid glands. This excess occurs due to an enlargement of one or more of the parathyroid glands, or a growth (usually not cancer) on one of the glands.

Other medical conditions can also cause hypercalcemia:

  • Adrenal gland failure
  • An inherited condition that affects the body’s ability to regulate calcium (familial hypocalciuric hypercalcemia)
  • Being bedbound (or not being able to move) for a long period of time
  • Calcium excess in the diet (called milk-alkali syndrome, usually due to at least 2,000 milligrams of calcium per day)
  • Hyperthyroidism
  • Kidney failure
  • Medications such as lithium and thiazide diuretics (water pills)
  • Some cancerous tumors (for example, lung cancers, breast cancer)
  • Vitamin D excess (hypervitaminosis D) from diet or inflammatory diseases

Who is at highest risk?

Women over age 50 are most likely to have hypercalcemia, usually due to primary hyperparathyroidism.

When to seek urgent medical care?

Hypercalcemia affects less than 1 percent of the population. The ability to measure blood calcium since the 1960s has improved detection. Today, the condition is diagnosed at an early stage so most patients with hypercalcemia have no symptoms.

Contact your physician or health care provider if you have:

  • Family history of hypercalcemia
  • Family history of hyperparathyroidism
  • Symptoms of hypercalcemia

Diagnosis

The cause of hypercalcemia must be identified, if possible, for this the physician may decide to obtain the following biomarkers:

  • Serum calcium
  • Serum PTH
  • Serum PTHrP (PTH-related protein)
  • Serum vitamin D level
  • Urine calcium

Treatment options

Treatment is aimed at the cause of hypercalcemia whenever possible. In people with primary hyperparathyroidism (PHPT), surgery may be needed to remove the abnormal parathyroid gland and cure the hypercalcemia.

However, if the hypercalcemia is mild, your health care provider will offer you the option of monitoring your condition closely over time.

Severe hypercalcemia that causes symptoms and requires a hospital stay is treated with the following:

  • Calcitonin
  • Dialysis
  • Diuretic medication, such as furosemide
  • Drugs that stop bone breakdown and absorption by the body, such as pamidronate or etidronate (bisphosphonates)
  • Fluids through a vein (intravenous fluids)
  • Glucocorticoids (steroids)

Medications to avoid

Patients diagnosed with hypercalcemia should avoid using the following medications:

  • Oxandrolone
  • SpironolactoneIf you have been diagnosed with hypercalcemia, consult your physician before starting or stopping any of these medications.

Where to find medical care for Hypercalcemia?

Ask our experts on Hypercalcemia

What to expect (Outlook/Prognosis)?

How well you do depends on the cause of hypercalcemia. Patients with mild hyperparathyroidism or hypercalcemia with a treatable cause do well and usually do not have complications.

Patients with hypercalcemia due to conditions such as cancer or granulomatous disease may not do well, but this is usually due to the disease itself, rather than the hypercalcemia.

Possible complications

Gastrointestinal:

  • Pancreatitis
  • Peptic ulcer disease

Kidney:

  • Calcium deposits in the kidney (nephrocalcinosis)
  • Dehydration
  • High blood pressure
  • Kidney failure
  • Kidney stones

Psychological:

  • Depression
  • Difficulty concentrating or thinking

Skeletal:

  • Bone cysts
  • Fractures
  • Osteoporosis

These complications of long-term hypercalcemia are uncommon today.

Prevention

Most causes of hypercalcemia cannot be prevented. Women over age 50 should see their health care provider regularly and have their blood calcium level checked if they have symptoms of hypercalcemia.

You can avoid hypercalcemia from calcium and vitamin D supplements by contacting your health care provider for advice about the dose if you are taking supplements without a prescription.

Sources

http://www.nlm.nih.gov/medlineplus/ency/article/000365.htm

Attribution

This article incorporates public domain material from Wikidoc and MedlinePlus. Please see licenses for further details.

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