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hypercalcemia
HYPERCALCEMIA
Treatment Guideline Chart
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
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