Hypercalcemia Signs and Symptoms

• 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

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

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