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Hypercalcemia

Definition

Hypercalcemia means you have too much calcium in your blood.

Alternative Names

Calcium - elevated; High calcium level; Hyperparathyroidism - hypercalcemia

Causes

Parathyroid hormone (PTH) and Vitamin D help manage calcium balance in the body.

  • PTH is made by the parathyroid glands. These are four small glands located in the neck behind the thyroid gland.
  • Vitamin D is obtained when the skin is exposed to sunlight, and from dietary sources.

The most common cause of high calcium blood level is excess PTH released by the parathyroid glands. This excess occurs due to:

  • An enlargement of one or more of the parathyroid glands.
  • A growth on one of the glands. Most of the time, these growths are benign.

Calcium blood level may also be high if your body is low on fluids or water.

Other conditions can also cause hypercalcemia:

  • Certain kinds of cancers, such as lung and breast cancer, or cancer that has spread to your organs.
  • Too much vitamin D in your system.
  • Being on bed rest for a long time.
  • Being bed-bound (or not being able to move) for a long period of time.
  • Too much calcium in your diet. This is called milk-alkali syndrome. It most often occurs when a person is taking more than 2000 milligrams of calcium bicarbonate supplements a day.
  • Overactive thyroid gland.
  • Chronic kidney disease or kidney failure.
  • Medicines such as lithium and thiazide diuretics (water pills).
  • Some infections or health problems such as, Paget's disease and sarcoidosis.
  • An inherited condition that affects the body's ability to manage calcium.

Men and women of all ages can have a high blood calcium level. However, it is most common in women over age 50 (after menopause). In most cases, this is due to an overactive parathyroid gland.

Symptoms

The condition is most often diagnosed at an early stage using routine blood tests. Most people have no symptoms.

Symptoms due to high calcium level may vary, depending on the cause and how long the problem has been present. They may include:

  • Digestive symptoms, such as nausea or vomiting, poor appetite, or constipation
  • Increased thirst or more frequent urination, due to changes in the kidneys
  • Muscle weakness or twitches
  • Changes in how your brain works, such as feeling tired or fatigued or confused
  • Bone pain and long-term spine changes, if the bones have become thinner or weaker

Exams and Tests

An accurate diagnosis is needed in hypercalcemia. Patients with kidney stones should have tests to evaluate for hypercalcemia.

Treatment

Treatment is aimed at the cause of hypercalcemia whenever possible. People with primary hyperparathyroidism (PHPT) may need surgery to remove the abnormal parathyroid gland. This will cure the hypercalcemia.

People with mild hypercalcemia may be able to monitor the condition closely over time.

Severe hypercalcemia that causes symptoms and requires a hospital stay may be treated with the following:

  • Fluids through a vein: this is the most important therapy
  • Calcitonin
  • Dialysis, if kidney damage is involved
  • Diuretic medication, such as furosemide
  • Drugs that stop bone breakdown and absorption by the body (bisphosphonates)
  • Glucocorticoids (steroids)

Outlook (Prognosis)

How well you do depends on the cause of your high calcium level. The outlook is good for people with mild hyperparathyroidism or hypercalcemia that have a treatable cause. Most of the time, there are no complications.

Patients with hypercalcemia due to conditions such as cancer or sarcoidosis may not do well. This is most often due to the disease itself, rather than the high calcium level.

Possible Complications

GASTROINTESTINAL

KIDNEY

PSYCHOLOGICAL

  • Depression
  • Difficulty concentrating or thinking

SKELETAL

These complications of long-term hypercalcemia are uncommon today.

When to Contact a Medical Professional

Contact your health care provider if you have:

  • Family history of hypercalcemia
  • Family history of hyperparathyroidism
  • Symptoms of hypercalcemia

Prevention

Most causes of hypercalcemia cannot be prevented. Women over age 50 should see their health care provider regularly and have their blood calcium level checked if they have symptoms of hypercalcemia.

Talk to your health care provider about the correct dose if you are taking calcium and vitamin D supplements.

References

Bringhurst FR, Demay MB, Kronenberg HM. Hormones and disorders of mineral metabolism. In: Melmed S, Polonsky KS, Crane RT, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016:chap 28.

Ferri FF. Milk-alkali syndrome. In: Ferri FF, ed. Ferri's Clinical Advisor 2016. Philadelphia, PA: Elsevier; 2016:803.

Thakker RV. The parathyroid glands, hypercalcemia, and hypocalcemia. In: Goldman L, Schafer AI, eds. Goldman' s Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 245.


Review Date: 2/3/2016
Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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