Hypercalcemia

Hypercalcemia

Hypercalcemia is a state of high calcium levels in your blood. Primary hyperparathyroidism, vitamin D toxicity, certain cancers, diseases, and medications can cause the condition. Treatment of hypercalcemia may involve medication or surgery.

What is hypercalcemia?

Hypercalcemia occurs when calcium levels in the bloodstream exceed the normal levels due to certain medications or health conditions, leading to bone weakening, kidney stones, and heart and brain malfunction. Calcium is an essential bodily mineral found mainly in bones. It helps with the functioning of the nervous system, heart, and muscle contraction. Two hormones control the calcium levels in the blood and bones -- parathyroid hormone and calcitonin. Moreover, vitamin D aids in absorbing calcium from food in the gut.

How common is hypercalcemia?

Approximately 1%-2% of the global population is diagnosed with hypercalcemia. It can affect people of all ages but is more common in women over 50, especially post-menopause. The majority of cases, around 90%, are linked to primary hyperparathyroidism and hypercalcemia of malignancy.

What are the symptoms of hypercalcemia?

In the early stages, hypercalcemia is often asymptomatic. Severe and chronic hypercalcemia can cause fatigue, increased urination and thirst, headaches, nausea, vomiting, constipation, loss of appetite, bone pain, muscle aches, muscle cramps, twitches, weakness, depression, forgetfulness, and irritability.

When should you see a doctor?

If you experience the abovementioned symptoms, consult your doctor for a proper diagnosis.

What are the causes of hypercalcemia?

The causes of hypercalcemia are certain medications, diseases, and dehydration. However, the primary causes are primary hyperparathyroidism and hypercalcemia of malignancy.

• Primary hyperparathyroidism

Our body has four parathyroid glands behind the thyroid gland in the neck. They work with the bones, kidneys, and intestines to maintain the level of blood calcium. When one or more parathyroid glands become overactive, they produce and release an excess of parathyroid hormone, elevating blood calcium levels.

• Malignancy induced hypercalcemia

Approximately 2% of all cancers may result in hypercalcemia. The hypercalcemia of malignancy typically occurs suddenly and is severe. Breast cancer, lung cancer, multiple myeloma, renal cell carcinoma, leukemia, lymphoma, and rhabdomyosarcoma are cancers that can induce this condition.

• Medications related hypercalcemia

Medications and supplements that can induce hypercalcemia include overconsumption of vitamin A, vitamin D, calcium supplements, lithium, hydrochlorothiazide, and other thiazide diuretics to treat high blood pressure and edema.

Less common causes of hypercalcemia encompass renal failure, sarcoidosis, tuberculosis, thyrotoxicosis, Paget's disease of the bone, and prolonged immobilization.

What are the complications of hypercalcemia?

Hypercalcemia is detectable at the early stages; therefore, complications are rare. But possible complications consist of nephrocalcinosis that can lead to poor kidney function, renal failure, kidney stones, hypertension, bone cysts, bone fractures, osteoporosis, and depression. 

What are the diagnostic tests for hypercalcemia?

• A basic metabolic panel (BMP) or comprehensive metabolic panel (CMP) usually includes a calcium blood test.
• Parathyroid hormone (PTH) blood test.
• Vitamin D blood test.
• Calcium urine test.

If you exhibit symptoms of hypercalcemia or are at risk of developing it due to cancer, your doctor will order blood tests for hypercalcemia. If your blood calcium level is high, your doctor will check your medical history, perform a physical exam, and ask about the medications you are taking. You may also be referred to an endocrinologist for further evaluation and testing if the cause of elevated calcium remains unidentified.

What are the abnormal blood calcium ranges?

1. Mild hypercalcemia: Blood calcium levels are between 10.6 and 11.9 milligrams per deciliter (mg/dL).
2. Moderate hypercalcemia: Blood calcium levels are 12.0 to 13.9 mg/dL.
3. Severe hypercalcemia: Blood calcium levels are higher than 14.0 mg/dL.

What are the treatments for hypercalcemia?

• Monitor and wait for mild hypercalcemia. Monitor your bones and kidneys to ensure their health and proper functioning.
• Medications for moderate to severe hypercalcemia
• Calcimimetics can manage hyperparathyroidism.
• Bisphosphonates are intravenous drugs for osteoporosis that can quickly lower calcium levels. They are used to manage hypercalcemia in cancer. Possible complications of these drugs include specific thigh fractures and osteonecrosis.
• Give Denosumab when bisphosphonates are ineffective in alleviating your symptoms.
• Prednisone can help treat hypercalcemia caused by elevated vitamin D levels.
• Giving IV fluids and diuretics to individuals with critically high calcium levels is deemed an emergency. These medications can swiftly lower calcium levels, averting irregular heartbeat and safeguarding the nervous system from harm.
• Removal of overactive parathyroid glans or injection of radionuclides into the malfunctioning gland

How can I prevent hypercalcemia?

• Have a proper treatment for the health condition that is the cause of hypercalcemia. 
• Take care of your health by drinking plenty of water and exercising. 
• Consult with your doctor before taking calcium and vitamin D supplements. 

What should I do before seeing a doctor?

Please list your symptoms, significant life events, medical history, and family history.

• Remember to bring all medications and vitamins you are currently taking.
• List all the questions you would like to ask your doctor. For instance:
  • What are the causes of my symptoms? 
  • Do I have to undergo any tests?
  • What treatment do you recommend? Are there any side effects?
  • How can I manage preexisting conditions?
• Prepare answers for the questions that your doctor may ask.
  
  • What improves or worsens your symptoms? 
  • Have you had a history of bone fractures, osteoporosis, and kidney stones?
  • Do you experience pain in the bone?
  • Do you have recently lost your weight?
  • Have you had a family history of kidney stones or hypercalcemia?