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.

Surgical Intervention

 Indications for Surgery

  •  Surgery is indicated for asymptomatic patients w/ primary hyperparathyroidism if any of the following are present:
    • Serum Ca >0.25 mmol/L (1 mg/dL) above upper limit of normal
    • Urinary Ca >400 mg/24 hr
    • Creatinine clearance reduced by >30%
    • W/ complications of primary hyperparathyroidism including osteoporosis (T score <-2.5 SD at any site), nephrocalcinosis or severe psychoneurologic disorder
      • Patient <50 years old
Parathyroidectomy
  • An option for patients w/ primary hyperparathyroidism
  • Controversy of medical vs surgical management of asymptomatic hypercalcemic patients
    • Cost, compliance & long-term follow-up are some arguments against medical management
    • Surgery is the only permanent cure
  • The following are used to facilitate targeted or minimally invasive parathyroidectomy: 99mTc-sestamibi scanning for preoperative localization, ultrasound & intraoperative measurement of circulating intact PTH
  • Effects: 95% of patients achieve normocalcemia if performed by experienced surgeon & pathologist
  • Complications: Vocal cord paralysis, permanent hypoparathyroidism
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Endocrinology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Tee Hoi Poh, 26 Sep 2018
Stool-based colorectal cancer (CRC) screening should be the preferred method of CRC screening in Malaysia, according to Dato Dr Muhammad Radzi Abu Hassan, the Head of Gastroenterology Services in Ministry of Health, Malaysia, who presented the Malaysian experience on CRC screening at the Annual Scientific Meeting of the Society of Gastroenterology and Hepatology (GUT) 2018 held recently in Penang.
Jackey Suen, 26 Nov 2018

Linagliptin has no impact on cognitive decline when given on top of standard of care in patients with type 2 diabetes mellitus (T2DM), a CARMELINA substudy has shown.