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 multiple endocrine neoplasia (MEN) syndrome

Parathyroid-Independent Hypercalcemia

  • Malignancy
    • Parathyroid hormone-related peptide (PTHrP)-dependent
    • Other humoral syndromes
    • Multiple myeloma & osteolytic metastases
  • Increased vitamin D/1,25(OH)2D
    • Vitamin D ingestion
    • Topical vitamin D analogues
    • Calcitriol intoxication
    • Granulomatous disease
    • Williams syndrome
  • Thyrotoxicosis
  • Adrenal insufficiency (AI)
  • Immobilization
  • Medications
    • Vitamin 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
  • Cardiovascular
    • Increased myocardial contractility
    • Shortened ventricular systole
    • Hypotension
    • Syncope from arrhythmias
    • Hypertension
    • Cardiomyopathy
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