hypercalcemia
HYPERCALCEMIA
Hypercalcemia is having serum calcium level of >10.5 mg/dL (>2.5 mmol/L).
Mild hypercalcemia is usually asymptomatic. While, more severe hypercalcemia has a constellation of clinical manifestations commonly described as "bones, abdominal moans, stones & groans."
Etiologies may be parathyroid-dependent or parathyroid independent.
Surgery is the treatment of choice for hypercalcemic patients with classic symptoms or complications of primary hyperparathyroidism.

Definition

  • Normal serum Ca level: 8-10 mg/dL (2-2.5 mmol/L)
  • Hypercalcemia: Serum Ca >10.5 mg/dL (>2.5 mmol/L)
    • Use total serum Ca level corrected for albumin concentration, by adding 0.8 mg/dL to the total serum Ca level for every 1g/dL drop in serum albumin <4g/dL

Etiology

Parathyroid-Dependent Hypercalcemia

  • Primary hyperparathyroidism
    • Leading cause of hypercalcemia
    • Some primary hyperparathyroidism are part of MEN syndrome

Parathyroid-Independent Hypercalcemia

  • Malignancy
    • Parathyroid hormone-related peptide (PTHrP)-dependent
    • Other humoral syndromes
    • Multiple myeloma & osteolytic metastases
  • Increased Vit D/1,25(OH)2D
    • Vit D ingestion
    • Topical Vit D analogues
    • Calcitriol intoxication
    • Granulomatous disease
    • Williams syndrome
  • Thyrotoxicosis
  • Adrenal insufficiency (AI)
  • Immobilization
  • Medications
    • Vit A
    • Milk-alkali syndrome
    • Thiazide diuretics
    • Theophylline

Signs and Symptoms

Mild Hypercalcemia

  • Usually asymptomatic

More Severe Hypercalcemia

  • Symptoms usually become more severe as serum Ca levels rise
  • The constellation of clinical manifestations are commonly described as “bones, abdominal moans, stones & groans”
  • Neurological
    • Mild drowsiness
    • Weakness
    • Depression
    • Lethargy
    • Stupor
    • Coma
    • Hypotonia, hyporeflexia
  • Gastrointestinal
    • Constipation
    • Nausea & vomiting (N/V)
    • Anorexia
    • Peptic ulcer disease (PUD)
  • Renal
    • Nephrogenic diabetes insipidus (DI)
    • Decreased glomerular filtration rate (GFR)
    • Nephrolithiasis
    • Nephrocalcinosis
    • Polyuria, nocturia
    • Dehydration
  • CV
    • Increased myocardial contractility
    • Shortened ventricular systole
    • Hypotension
    • Syncope from arrhythmias
    • Hypertension
    • Cardiomyopathy
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Endocrinology - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
Roshini Claire Anthony, 05 Oct 2017

Olfactory impairment in older adults may point to an elevated risk of developing Parkinson’s disease (PD), particularly in Caucasian men, a small US study found.

Elvira Manzano, Yesterday
Bisphosphonates have proven antifracture efficacy and remain to be the cornerstone of osteoporosis treatment. However, a drug holiday is of particular importance with bisphosphonates due to some signals with long-term use of the drug, including rare incidence of atypical femoral fracture (AFF) and osteonecrosis of the jaw (ONJ), says a leading endocrinologist at AFOS 2017.
07 Oct 2017
Women who follow a low-fat dietary pattern appear to have reduced breast cancer mortality, according to data from the Earlier Women’s Health Initiative Dietary Modification trial.
Pearl Toh, 5 days ago
Women with higher plasma tryptophan concentrations were less likely to have poor sleep quality during pregnancy, especially among those with anxiety symptoms, according to the GUSTO* study.