Hypercalcemia


Article Author:
Nazia Sadiq
Srividya Naganathan


Article Editor:
Madhu Badireddy


Editors In Chief:
Stephen Leslie
Karim Hamawy


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Trevor Nezwek
Radia Jamil
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Steve Bhimji
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Nazia Sadiq
Hajira Basit
Phillip Hynes
Tehmina Warsi


Updated:
7/24/2019 3:00:48 PM

Introduction

Calcium is the most abundant cation found in the human body and plays an integral role in neural transmission, enzyme activity, myocardial function, coagulation and other cellular functions. Most of the calcium is found in the bones as calcium phosphate while a small percentage is found in the cells and extracellular fluids. In the serum, about 45% of calcium is bound to proteins, 45% exists as free or ionized calcium, the active form, while 10% is bound to anions. Systemic acidosis decreases calcium binding to albumin increasing serum levels while alkalosis causes the opposite effect. Serum calcium concentrations are highest in neonates and infants, decrease during childhood and adolescence, and stabilize at adult values by 17 years of age. Hypercalcemia is defined as serum calcium concentration two standard deviations above the mean values. The normal serum calcium ranges from 8.8 mg/dL-10.8 mg/dL. Primary hyperparathyroidism and malignancy accounts for 90% of the cases of hypercalcemia. [1][2]

Etiology

The main cause of hypercalcemia is an excess parathyroid hormone (PTH). PTH-mediated causes include adenoma/hyperplasia of the gland, familial hypocalciuric hypercalcemia, and multiple endocrine neoplasia syndromes (type1, 2A). Familial hypocalciuric hypercalcemia is an autosomal dominant condition due to an inactivating mutation in the calcium-sensing receptor gene. 

Although more common in adults than pediatric patients, the next important etiology to consider is a malignancy. Renal carcinomas, leukemias, lymphomas, and rhabdomyosarcoma can be associated with elevated calcium levels mediated by the action of PTH-related peptides.

Hypervitaminosis D can be iatrogenic, secondary to excessive milk intake, or related to granulomatous conditions such as sarcoidosis, tuberculosis or fungal infections.

Endocrine causes such as thyrotoxicosis (due to stimulation of osteoclast function by thyroid hormone), hypoadrenalism and pheochromocytomas can be associated with hypercalcemia.

Other miscellaneous causes include Williams syndrome, Murk Jansen syndrome, hypophosphatasia, hypervitaminosis A, acute/chronic renal failure, use of thiazide diuretics or lithium, milk-alkali syndrome, subcutaneous fat necrosis, and prolonged immobilization. Williams-Beuren syndrome is characterized by elfin facies, subvalvular aortic stenosis, short stature, and developmental delay. Features of Murk Jansen syndrome include extreme short stature (short-limbed dwarfism), prominent eyes, high-arched palate, wide open fontanelles and micrognathia.[3][4]

Epidemiology

The prevalence of hypercalcemia in the general population is approximately 1% to 2%. Most of the cases (90%) of hypercalcemia are secondary to primary hyperparathyroidism and malignancy-associated hypercalcemia. The prevalence of primary hyperparathyroidism in the general population ranges from 0.2% to 0.8% and increases with age. Overall, 2% of all cancers are associated with hypercalcemia, but in the pediatric age group, the prevalence is about 0.4% to 1.3%.[5]

Pathophysiology

Calcium concentration is regulated by plasma membrane calcium receptor, PTH and its receptor, calcitonin and its receptor, and by the actions of vitamin D on kidneys, bone, and intestines. PTH mobilizes calcium directly by enhancing bone resorption, and indirectly, by stimulating one alpha-hydroxylase which increases vitamin D3 production, in turn, leading to increased absorption of calcium from the gut and increased bone resorption. Primary hyperparathyroidism is due to a solitary adenoma or diffuse hyperplasia of the gland. In this condition, there is an abnormal set point in the relation between calcium and PTH levels and calcium-independent PTH secretion.  Familial hypocalciuric hypercalcemia is inherited autosomal dominant pattern and is due to an inactivating mutation in the calcium-sensing receptor gene. Granulomatous lesions cause ectopic vitamin D production. Transient neonatal hypercalcemia can rarely be seen in infants born to mothers with hypoparathyroidism.[6]

Hypercacemia from hyperparathyroidism is mild and could go one for years and be asymptomatic. Hypercalcemia from malignancy is assoicated with rapidly increasing calcium levels

History and Physical

Symptoms of hypercalcemia are usually seen when serum calcium levels are more than 12 mg/dl. Irrespective of the etiology, the broad signs and symptoms can be summarized as "groans, bones, stones, moans, thrones and psychic overtones".

  • Groans: Gastrointestinal symptoms like pain, nausea, and vomiting. Hypercalcemia can lead to peptic ulcer disease and pancreatitis.
  • Bones: Bone related complications like bone pain. Hypercalcemia can lead to osteoporosis, osteomalacia, arthritis and pathological fractures.
  • Stones: Renal stones causing pain.
  • Moans: Refers to fatigue and malaise.
  • Thrones: Polyuria, polydypsia and constipation (sitting on toilet as you are sitting on a throne).
  • Psychic overtones: Lethargy, confusion, depression and memory loss.

Severe hypercalcemia inhibits neuromuscular and myocardial depolarization leading to muscle weakness and arrhythmias. Cardiovascular effects include prolonged PR interval, short QT interval, widened QRS complex, and bradycardia. Increased thirst with polydipsia and polyuria is seen initially, progressing to nephrolithiasis and nephrocalcinosis in chronic cases. Neurologic features include impaired concentration, altered mental status ranging from confusion to irritability. Levels of more than 14 mg/dL can cause encephalopathy and levels above 15 mg/dL is a medica emergency. Severe acute abdominal pain should be a clue to evaluate for pancreatitis. Osseous changes can lead to bone pain, gait abnormalities, and fractures and are seen radiologically as subperiosteal and endosteal bone resorption. In infants and young children, hypercalcemia can cause poor weight gain and failure to thrive.

Evaluation

Hypercalcemia can be calssified into

  • Mild hypercalcemia: 10.5 to 11.9 mg/dL
  • Moderate hypercalcemia: 12.0 to 13.9 mg/dL
  • Hypercalecemic crisis: 14.0 to 16.0 mg/dL

Most cases of hypercalcemia are detected on routine testing. Work up for etiology includes obtaining serum PTH, calcitonin, Vitamin D, ionized calcium, phosphorus, magnesium, alkaline phosphatase levels, renal functions, and urinary calcium-creatinine ratio. Sensitive and specific immunochemiluminometric assays should be used to measure parathyroid hormone (PTH) (i-PTH). Hyperparathyroidism is characterized by high calcium, high i-PTH levels with low phosphorous levels. Familial hypocalciuric hypercalcemia has inappropriately normal PTH levels with high magnesium and low calcium creatinine clearance. Other causes of hypercalcemia typically have low PTH levels. Patients with hypercalcemia and hypervitaminosis D have high serum concentrations of calcidiol, whereas, patients with a granulomatous disease have high levels of calcitriol. In patients with hypercalcemia associated with malignancy, the PTH-related peptide levels are elevated. Imaging is indicated to identify nephrolithiasis and nephrocalcinosis. Neonates and infants who are found to be hypercalcemic in the presence of dysmorphic features should prompt evaluation for Williams or Murk Jansen syndrome.[1][7]

Treatment / Management

Treatment for hypercalcemia is required if the patient is symptomatic or if the calcium level is more than 15 mg/dL, even in asymptomatic patients. The goals of treating hypercalcemia include increased elimination from the extracellular fluid, reducing gastrointestinal (GI) absorption and decreasing bone resorption. Immediate therapy is directed at restoring intravascular volume and promoting calcium excretion in the urine with an infusion of 0.9% saline at twice the maintenance rate until any fluid deficit is replaced and diuresis occurs (urine output ≥ 200 mL/h to 300 mL/h). Hemodialysis is the treatment of choice to rapidly decrease serum calcium in patients with heart failure or renal insufficiency. Loop diuretics should be used with caution as even though they may enhance renal excretion, paradoxical hypercalcemia can occur due to bone resorption. Patients with hyperparathyroidism require surgical exploration and removal of the source of increased PTH secretion. Postoperatively, patients need to be monitored closely for development of hypocalcemia and tetany. Bisphosphonates such as etidronate, pamidronate, and alendronate are the drugs of choice for hypercalcemia of malignancy as they inhibit osteoclastic activity. Hypercalcemia associated with excess vitamin D can be treated with steroids as they inhibit one alpha-hydroxylase activity. Ketoconazole, an antifungal agent, has also been used in hypervitaminosis D as it inhibits 1-alpha hydroxylase activity. Hypercalcemia of immobilization can be prevented by encouraging activity as tolerated and adequate hydration.The specific cause of hypercalcemia needs to be identified, and treatment directed accordingly.[8][9][10]

Differential Diagnosis

Prognosis

Hypercalcemia, when it occurs following a benign disorder, has a good prognosis but when the cause is secondary to a malignancy the prognosis is poor. Patients with hypercalcemia associated with a malignancy are often symptomatic and need frequent hospitalizations.

Complications

Pearls and Other Issues

Hypercalcemia should be confirmed by taking into account the serum albumin level and measuring an ionized calcium level.

Enhancing Healthcare Team Outcomes

Multidisciplinary Approach

Hypercalcemia is not an uncommon presentation to the hospital. The severity of the symptoms are related to the speed of development and the concentration of calcium. This metabolic problem can present in many ways, and only a multidisciplinary approach can help make a prompt diagnosis. Without treatment, the condition carries a very high morbidity. Besides physicians, nurses play a vital role in the management of patients with hypercalcemia. Patients should be educated about hydration, changes in diet and limiting calcium intake. The patient and family should be told about the symptoms of hypercalcemia and when to seek assistance. The pharmacist should check the medications to ensure that the cause is not due to the drug. In addition. The patient should be educated about the compliance with the bisphosphonates. Finally, a dietitian should be consulted to educate the patient on what type of foods to avoid.[11][12] (Level III)

Outcomes

The outcomes depend on the cause of hypercalcemia. When the condition is due to hyperparathyroidism, symptoms tend to be mild but are prolonged. The highest morbidity is due to bone wasting. Mild hypercalcemia does not lead to mortality. However, hypercalcemia from a malignant cause carries a grave prognosis. These patients need aggressive treatment and also require frequent admissions to the hospital. Finally, the morbidity from the malignancy associated hypercalcemia can be severe leading to many symptoms and a very poor quality of life.[7][13] (Level V)


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Hypercalcemia - Questions

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Which of the following agent can be used as first-line therapy in lowering an elevated serum calcium?



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Which of the following is not a feature of hypercalcemia?



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A patient is found to have high levels of calcium on a routine laboratory examination. She denies any symptoms. Which of the following is false about hypercalcemia?



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In which of the following disorders does one not see hypercalcemia?



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Which of the following is a treatment for patients with repeated calcium deposits into the kidney?



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Which of the following statements is true regarding hypercalcemia?



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A 45-year-old female is on lisinopril and chlorthalidone for hypertension. Her vital signs are normal. Exam is normal. Labs show WBC 9,000, Na 138 mEq/L, Hgb 12.3 g/dL, Hct 37%, Plts 250,000, K 3.9 mEq/L, creatinine 1.0 mg/dL, BUN 12 mg/dL, Cl 110 mEq/L, Ca 12.8 mg/dL, and CO2 24 mEq/L. Which of the following is the most likely cause of the spurious elevation of calcium?



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A 45-year-old female is on lisinopril and chlorthalidone for hypertension. Her vital signs are normal. Exam is normal. Labs show WBC 9,000, Na 138 mEq/L, Hgb 12.3 g/dL, Hct 37%, platelets 250,000, K 3.9 mEq/L, creatinine 1.0 mg/dL, BUN 12 mg/dL, Cl 110 mEq/L, Ca 12.8 mg/dL, and CO2 24 mEq/L. The calcium level is repeated and is even higher. Which of the following is most appropriate for the management of this patient?



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A healthy asymptomatic 50-year-old male has a calcium of 12.5 mg/dL. A repeat calcium is 12.9 mg/dL. The patient is not on any medications and has no symptoms. Which of the following would be appropriate management?



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Which of the following conditions does not cause hypercalcemia?



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A 65-year-old female who weighs 70 kg is unresponsive and appears to be dehydrated. Her blood pressure is 100/60 mmHg, and her heart rate is 100 beats/min. An EKG shows ST depression. Blood work shows a serum calcium of 14.2 mg/dL, serum phosphorus of 2.9 mg/dL (normal 3 to 6 mg/dL), and potassium of 2.9 mEq/L. A small amount of urine is obtained by a catheter. Which of the following would not be included in the treatment over the next hour?



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Mithramycin is similar to dactinomycin and is used in treating testicular cancer. What other condition is it used to treat?



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Which of the following is not associated with hypercalcemia?



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Which of the following is not a symptom of hypercalcemia?



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Which of the following is the diuretic of choice for the treatment of hypercalcemia?



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What is the effect of hypercalcemia on nerves and cardiac muscles?



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A 71-year-old has uncontrolled atrial fibrillation. He is cardioverted and then started on oral digoxin therapy. He is later seen in the emergency room with complaints of diarrhea, yellow vision, and first-degree heart block. His condition can easily be worsened by which of the following?



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Which of the following conditions is NOT associated with hypercalcemia?



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Which medical disorder is associated with hypercalcemia?



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Why is a patient with hypercalcemia administered phosphate?



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In patients with hypercalcemia, what is the prevalence of kidney stones?



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What is the best initial management of a patient with hypercalcemia?



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Which of the following is NOT associated with hypercalcemia?



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Which of the following symptoms is not caused by hypercalcemia?



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Which of the following is not an effect of hypercalcemia?



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Which is the best initial treatment of hypercalcemia?



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Which clinical disorder is not associated with hypercalcemia?



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Which is not a common feature of hypercalcemia?



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Why are steroids are given to treat hypercalcemia?



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Which of the following does not cause hypercalcemia?



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Which would not be helpful in the treatment of hypercalcemia?



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Which does not suggest hypercalcemia?



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A 16-year-old girl has been in a double hip spica cast after a motor vehicle accident for Six weeks. She develops constipation and nausea. She is listless and depressed. Her blood pressure is 145/100 mmHg and has microscopic hematuria. Select appropriate management.



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What is the most common cause of hypercalcemia?



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A calcium level of 15 mg/dL is most likely diagnostic of which of the following?



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Hypercalcemia - References

References

Bilezikian JP, Primary Hyperparathyroidism. The Journal of clinical endocrinology and metabolism. 2018 Jul 27     [PubMed]
Carrick AI,Costner HB, Rapid Fire: Hypercalcemia. Emergency medicine clinics of North America. 2018 Aug     [PubMed]
Efthymiou C,Spyratos D,Kontakiotis T, Endocrine paraneoplastic syndromes in lung cancer. Hormones (Athens, Greece). 2018 Jul 2     [PubMed]
Alon US, The Effects of Diuretics on Mineral and Bone Metabolism. Pediatric endocrinology reviews : PER. 2018 Mar     [PubMed]
Catalano A,Chilà D,Bellone F,Nicocia G,Martino G,Loddo I,Morabito N,Benvenga S,Loddo S, Incidence of hypocalcemia and hypercalcemia in hospitalized patients: Is it changing? Journal of clinical     [PubMed]
Wagner J,Arora S, Oncologic Metabolic Emergencies. Hematology/oncology clinics of North America. 2017 Dec     [PubMed]
Reid L,Muthukrishnan B,Patel D,Crane M,Akyol M,Thomson A,Seckl JR,Gibb FW, Presentation, diagnostic assessment and surgical outcomes in primary hyperparathyroidism: a single centre's experience. Endocrine connections. 2018 Aug 23     [PubMed]
Simm PJ,Biggin A,Zacharin MR,Rodda CP,Tham E,Siafarikas A,Jefferies C,Hofman PL,Jensen DE,Woodhead H,Brown J,Wheeler BJ,Brookes D,Lafferty A,Munns CF, Consensus guidelines on the use of bisphosphonate therapy in children and adolescents. Journal of paediatrics and child health. 2018 Mar     [PubMed]
Mannstadt M,Bilezikian JP,Thakker RV,Hannan FM,Clarke BL,Rejnmark L,Mitchell DM,Vokes TJ,Winer KK,Shoback DM, Hypoparathyroidism. Nature reviews. Disease primers. 2017 Aug 31     [PubMed]
Walker J, Diagnosis and management of patients with hypercalcaemia. Nursing older people. 2015 May     [PubMed]
Hoyoux C,Lombet J,Nicolescu CR, Malignancy-Induced Hypercalcemia-Diagnostic Challenges. Frontiers in pediatrics. 2017     [PubMed]
Wood L,Jacobs P, Myeloma--the integral role played by the professional nurse. Curationis. 1989 Dec     [PubMed]
Mhaskar R,Kumar A,Miladinovic B,Djulbegovic B, Bisphosphonates in multiple myeloma: an updated network meta-analysis. The Cochrane database of systematic reviews. 2017 Dec 18     [PubMed]
Curtin M,Piggott RP,Murphy EP,Munigangaiah S,Baker JF,McCabe JP,Devitt A, Spinal Metastatic Disease: A Review of the Role of the Multidisciplinary Team. Orthopaedic surgery. 2017 May;     [PubMed]

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