Hypercalcemia

Hypercalcaemia can be an asymptomatic laboratory finding, but because an elevated calcium level is often a clue to other serious disease, a diagnosis should be undertaken if it persists.

Hypercalcemia per se can result in fatigue, depression, confusion, anorexia, nausea, vomiting, constipation, or increased urination; if it is chronic it can result in urinary calculi (renal stones or bladder stones). Abnormal heart rhythms can result, and an EKG finding of a short QT interval suggests hypercalcemia. Symptoms are more commin at high calcium levels (11.5-12.0 mg/dL). Severe hypercalcemia (15 mg/dL or more) is considered a medical emergency: at these levels, coma and cardiac arrest can result.

Causes

• abnormal parathyroid gland function
  • primary hyperparthyroidism
    • solitary adenomas
    • multiple endocrine neoplasia (MEN)
  • lithium use
  • familial hypocalciuric hypercalcemia
• malignancy
  • solid tumor with metastasis (e.g. breast cancer)
  • solid tumor with humoral mediation of hypercalcemia (e.g. lung or kidney cancer)
  • hematologic malignancy (multiple myeloma, lymphoma, leukemia
• vitamin-D metabolic disorders
  • hypervitaminosis D (vitamin D intoxication)
  • elevated 1,25(OH)₂D levels (e.g. sarcoidosis and other granulomatous diseases)
  • idiopathic hypercalcemia of infancy
• disorders related to high bone-turnover rates
  • hyperthyroidism
  • prolonged immobilization
  • thiazide use
  • vitamin A intoxication
• renal failure
  • severe secondary hyperparathyroidism
  • aluminum intoxication