HYPERCALCEMIA
Hypercalcemia is a condition characterized by a high concentration of calcium in the blood.
- Calcium is needed for the normal functions of organs, nerves, tissues, cells, and also essential in blood clotting and bone health.
- The normal range is 2.1-2.6 mmol/L with levels more than 2.6mmol/L defined as hypercalcemia.
- A higher concentration of calcium in the blood can result in bone weakness, create kidney stones and interfere with the functionality of the brain and heart.
- Other complications of hypercalcemia may include osteoporosis (bone-thinning disease), kidney failure and nervous system problems such as coma, dementia, and confusion.
- Extremely high levels of calcium can be risky and life-threatening.
CAUSES
HYPERPARATHYROIDISM
Calcium balance is maintained in the body by vitamin D and parathyroid hormone (PTH).
PTH is made by parathyroid glands, which are four tiny glands situated in the neck behind the thyroid gland.
The amount of calcium that comes into the blood from the intestines, bones, and kidneys are controlled by the PTH.
Normally, there is a rise in the PTH when the calcium level in the blood falls and a decrease when the calcium level rises.
Hyperparathyroidism occurs when one of the parathyroid glands becomes overactive and releases too much PTH.
The most common cause of this excess PTH are: an enlargement of one or more of the parathyroid glands, or a growth usually benign on one of the glands.
Hyperparathyroidism is the most common cause of hypercalcemia, especially in women older than 50.
Other causes include:
- Cancer including lung, breast, or bone cancer
- Severe hydration
- Lung diseases such as tuberculosis, and sarcoidosis which can raise vitamin D levels
- Medications such as thiazide diuretics and lithium
- Prolonged immobilization
- Excessive usage of calcium and vitamin supplements
- A genetic disorder referred to as familial hypocalciuric hypercalcemia
- A milk-alkali syndrome caused by taking too much calcium and absorbable alkali
- Adrenal insufficiency.
SYMPTOMS
For mild cases, symptoms are often not noticeable. However, in serious cases, symptoms may affect various parts of your body.
KIDNEYS
- Excessive thirst and urination
- Pain between your back and upper abdomen due to kidney stones
HEART
- Palpitations and fainting
- Abnormal heart rhythms
ABDOMEN
- Abdominal pain
- Constipation
- Nausea
- Vomiting
- Decreased appetite
BONE AND MUSCLES
- Bone pain
- Muscle weakness
- Muscle twitches and muscle cramps
- Osteoporosis
- Fractures from diseases
NEUROLOGICAL SYMPTOMS
- Depression
- Memory loss
- Anxiety
- Coma and confusion may occur in severe cases
DIAGNOSIS AND TREATMENT
To make a diagnosis, the doctor may use blood tests to check the level of calcium in your blood.
Urine tests can also be helpful as it measures calcium, proteins, and other substances.
If your doctor detects a high calcium level, imaging tests such as X-rays, CT scans, MRI scans, mammogram, can be used to check underlying problems such as cancer and sarcoidosis.
DEXA bone mineral density tests can also be used to check the strength of your bones.
TREATMENT
For mild cases, you and your doctor may choose to wait to monitor the progress of your bones and kidney overtime to be sure they remain healthy.
It is important to stick to your doctor’s recommendation for follow up as mild cases can result in kidney damage and kidney stone with time.
If your condition is beyond mild, the goal of treatment would be to return your calcium to the normal level as well as prevent your bones and kidneys. To do that, your doctor may prescribe medications including:
- Calcitonin (Miacalcin)
- Calcimimetics
- Prednisone
- Denosumab
- IV fluids and diuretics
- Bisphosphonate
In the case of hyperparathyroidism, surgical procedures can be used to remove the tissue causing the problem. This procedure cures most cases of hypercalcemia caused by hyperparathyroidism.
If you have cancer, your doctor may discuss treatment options with you to determine how best to treat your condition.