hypercalcemia

What is Hypercalcemia?

Hypercalcemia is a condition in which the calcium level in the blood becomes too high. This can occur when there is an excessive amount of calcium entering the extracellular fluid or when the kidneys are unable to excrete enough calcium.

• Causes: Primary hyperparathyroidism and malignancy-associated hypercalcemia are the most common causes of hypercalcemia, accounting for more than 90% of cases [7].
• Symptoms: The earliest symptoms of hypercalcemia can be mild and may include constipation, nausea, vomiting, abdominal pain, and loss of appetite [3].
• Characteristics: Hypercalcemia is a relatively common clinical problem that typically manifests as a mild chronic calcium level elevation, although hypercalcemic emergencies can also occur [5].

Key Points

• Hypercalcemia occurs when the calcium level in the blood becomes too high.
• The condition can be caused by excessive bone resorption or kidney dysfunction.
• Primary hyperparathyroidism and malignancy-associated hypercalcemia are the most common causes of hypercalcemia.
• Symptoms may include constipation, nausea, vomiting, abdominal pain, and loss of appetite.

References

[1] Mar 8, 2024 — Hypercalcemia is a condition in which the calcium level in the blood becomes too high. Too much calcium in the blood can weaken bones and ... [3] Hypercalcemia often causes few symptoms. The earliest symptoms of hypercalcemia are usually constipation, nausea, vomiting, abdominal pain, and loss of appetite ... [5] Mar 12, 2024 — Description · Hypercalcemia is a common metabolic disorder characterized by serum calcium levels above the upper limit of normal, which is most ... [7] Primary hyperparathyroidism and malignancy-associated hypercalcemia are the most common causes of hypercalcemia, together accounting for more than 90% of cases.

Common Signs and Symptoms of Hypercalcemia

Hypercalcemia, a condition characterized by elevated calcium levels in the blood, can manifest in various ways. The symptoms can range from mild to severe and may vary depending on individual factors.

• Digestive Issues: Many people experience digestive problems such as:
  • Nausea or vomiting [2]
  • Poor appetite [4]
  • Constipation [1, 5]
• Increased Thirst and Urination: Changes in the kidneys can lead to increased thirst and more frequent urination [2]
• Musculoskeletal Symptoms:
  • Muscle weakness [7]
  • Bone pain [7]
• Central Nervous System Symptoms:
  • Lethargy [6, 7]
  • Confusion [6, 7]
  • Stupor or coma in severe cases [7]

It's essential to note that some individuals may be asymptomatic or experience only mild symptoms, especially in the early stages of hypercalcemia.

References: [1] Mar 8, 2024 — Hypercalcemia can cause stomach upset or pain, vomiting, and constipation. [2] Digestive symptoms, such as nausea or vomiting, poor appetite, or constipation · Increased thirst or more frequent urination, due to changes in the kidneys ... [3] by E Shane · Cited by 20 — may be asymptomatic, or they may report nonspecific symptoms, such as constipation, fatigue, and depression. [4] The earliest symptoms of hypercalcemia are usually constipation, nausea, vomiting, abdominal pain, and loss of appetite. People may excrete abnormally large ... [5] In mild hypercalcemia, many patients are asymptomatic. Clinical manifestations of hypercalcemia include constipation, anorexia, nausea and vomiting, abdominal ... [6] Jun 7, 2022 — History may also identify symptoms of high calcium such as renal stones (typical of hyperparathyroidism), lethargy, easy fatigue, confusion, ... [7] Signs and symptoms · Lethargy · Muscle weakness · Bone pain · Confusion · Stupor · Coma.

Diagnostic Tests for Hypercalcemia

Hypercalcemia, or elevated calcium levels in the blood, can be diagnosed through various tests. Here are some of the diagnostic tests used to determine the cause and extent of hypercalcemia:

• Calcium Blood Test: A simple blood test measures the level of calcium in the blood to confirm hypercalcemia [5].
• Parathyroid Hormone (PTH) Testing: PTH testing is essential to determine if the cause of hypercalcemia is related to parathyroid gland dysfunction [2, 6].
• Imaging Tests: Imaging tests such as X-rays or CT scans may be ordered to evaluate bone density and rule out conditions like cancer or sarcoidosis [1].
• Laboratory Testing: Additional laboratory testing may include identifying organ involvement and testing for low PTH levels [2].
• Peripheral Blood Smear and Serum/Urine Immunofixation Electrophoresis: These tests may be ordered to diagnose underlying conditions such as multiple myeloma or other bone diseases [7].

Additional Tests

In some cases, further testing may be necessary to determine the cause of hypercalcemia. This may include:

• Bone Biopsy: A bone biopsy may be taken to evaluate bone density and rule out conditions like cancer or sarcoidosis [7].
• Serum Ionized Calcium and Parathyroid Hormone Concentrations: These tests are used to confirm the diagnosis of hypercalcemia and determine the underlying cause [6].

References

[1] Mar 8, 2024 — You might need imaging tests of your bones or lungs. This helps find out if the cause is a disease such as cancer or sarcoidosis. [2] Oct 10, 2023 — Laboratory testing includes parathyroid hormone (PTH) testing, testing to identify organ involvement, and, in the event of low PTH, testing for ... [5] Dec 5, 2023 — A calcium test measures the level of calcium in your blood. Abnormal calcium levels may indicate bone disease or other medical conditions. [6] Diagnosis is by measuring serum ionized calcium and parathyroid hormone concentrations. Treatment to increase calcium excretion and reduce bone resorption of ... [7] Apr 26, 2023 — Testing in such cases might include a peripheral blood smear and/or serum and urine immunofixation electrophoresis. Biopsy samples may be taken ...

Treatment Options for Hypercalcemia

Hypercalcemia, or elevated calcium levels in the blood, can be treated using various medications and therapies. The primary goal of treatment is to lower calcium levels and alleviate symptoms.

• Volume Repletion: The first step in treating hypercalcemia is volume repletion with intravenous saline infusion [2]. This helps to dilute the calcium levels in the blood.
• Bisphosphonates: Intravenous bisphosphonates are considered the treatment of choice for initial management of hypercalcaemia, followed by continued oral or repeated doses as needed [4].
  • Pamidronate (Aredia): This is a type of bisphosphonate that can be used to treat hypercalcemia in cancer patients who do not respond to other treatments [6].
• Calcitonin: Calcitonin is another medication that can help lower calcium levels by inhibiting osteoclast activity and promoting bone resorption [3].
• Denosumab (XGEVA): This is a bone-strengthening medication used for people with cancer-caused hypercalcemia who do not respond to bisphosphonates [5].

Other Treatment Options

• Glucocorticoids: These medications can help lower calcium levels by inhibiting osteoclast activity and promoting bone resorption.
• Gallium nitrate: This medication can also be used to treat hypercalcemia, particularly in patients with cancer.

Important Considerations

• Thiazide diuretics: While these medications can increase renal calcium resorption, they should not be used as a treatment for hypercalcemia [7].
• Cinacalcet: This medication is recommended as first-line treatment in patients with mild hypercalcaemia resulting from parathyroid carcinoma [9].

It's essential to consult with a healthcare professional to determine the best course of treatment for individual cases of hypercalcemia.

Hypercalcemia Differential Diagnosis

Hypercalcemia, a condition characterized by elevated calcium levels in the blood, has a wide range of potential causes. The differential diagnosis for hypercalcemia involves identifying and ruling out various conditions that can lead to this condition.

Common Causes of Hypercalcemia

According to search results [1] and [3], primary hyperparathyroidism and malignancy account for more than 90% of all hypercalcemic cases. These two conditions are the most common causes of hypercalcemia, and it is essential to differentiate them early on.

• Primary Hyperparathyroidism: This condition occurs when one or more parathyroid glands produce excess parathyroid hormone (PTH), leading to increased calcium levels in the blood [1].
• Malignancy: Cancer can cause hypercalcemia through various mechanisms, including the production of PTH-related protein (PTHrP) by tumor cells [8].

Other Causes of Hypercalcemia

In addition to primary hyperparathy