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Related Subjects: | Familial Hypocalciuric Hypercalcaemia (FHH) | Primary Hyperparathyroidism | Lung Cancer | Hypercalcaemia | Multiple Myeloma | Oncological Emergencies | Bisphosphonates
An albumin-adjusted serum calcium level above 2.6 mmol/L (UK) is considered hypercalcemia. More than 90% of cases are due to malignancy or primary hyperparathyroidism.
Initial Hypercalcemia: Total Serum Calcium >10.5 mg/dL (2.6 mmol/L). |
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Cause | Clinical Features | Investigations | Management |
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Primary Hyperparathyroidism | Often asymptomatic; may present with bone pain, fractures, nephrolithiasis, polyuria, constipation, and mental disturbances ("stones, bones, abdominal groans, and psychiatric overtones"). | Elevated serum calcium, elevated or inappropriately normal PTH, low serum phosphate, increased urinary calcium excretion. | Surgical removal of overactive parathyroid gland(s), hydration, bisphosphonates for bone protection, monitoring in mild cases. |
Malignancy-Associated Hypercalcemia | Symptoms of advanced malignancy, such as weight loss, fatigue, bone pain, polyuria, dehydration, and confusion. | Elevated serum calcium, suppressed PTH, elevated PTHrP in humoral hypercalcemia, imaging to identify primary tumour/metastases. | IV fluids, bisphosphonates, denosumab, treat underlying malignancy, corticosteroids in select cases. |
Vitamin D Toxicity | Symptoms include nausea, vomiting, polyuria, dehydration, and confusion, often related to excessive vitamin D/calcium intake. | Elevated serum calcium, elevated 25-hydroxyvitamin D, suppressed PTH, normal or elevated phosphate. | Discontinue vitamin D and calcium, hydration, corticosteroids, bisphosphonates in severe cases. |
Sarcoidosis / Granulomatous Diseases | Symptoms of hypercalcemia, such as polyuria and fatigue; may also present with respiratory issues in sarcoidosis. | Elevated serum calcium, elevated 1,25-dihydroxyvitamin D, suppressed PTH, imaging/biopsy for granulomas. | Corticosteroids to reduce granulomas, hydration, bisphosphonates in severe cases. |
Thiazide Diuretics | Mild, asymptomatic hypercalcemia; may exacerbate underlying hyperparathyroidism. | Elevated serum calcium, suppressed PTH, history of thiazide use, exclusion of other causes. | Discontinue thiazide, monitor calcium levels, treat underlying conditions. |
Familial Hypocalciuric Hypercalcemia (FHH) | Mild hypercalcemia, often asymptomatic, family history of hypercalcemia; typically presents in childhood or early adulthood. | Elevated serum calcium, low urinary calcium, genetic testing for CASR mutations, normal/mildly elevated PTH. | No treatment required; genetic counseling may be offered. |
Immobilization | Hypercalcemia in patients with prolonged immobilization, particularly those with high bone turnover (e.g., Paget's disease, adolescents). | Elevated serum calcium, normal/suppressed PTH, history of immobilization, elevated bone turnover markers. | Increased mobility, bisphosphonates, hydration. |
Hyperthyroidism | Symptoms of hyperthyroidism (e.g., weight loss, tachycardia) with mild hypercalcemia. | Elevated serum calcium, suppressed PTH, elevated thyroid hormones (T3, T4), suppressed TSH. | Treat hyperthyroidism, hydration, bisphosphonates if severe. |