Hypercalcemia: Symptoms, Causes, Treatment

What are the symptoms of hypercalcemia?

Hypercalcemia refers to high levels of calcium in the blood, which can lead to various symptoms depending on the severity. Common symptoms include:

1. Digestive Issues: Nausea, vomiting, constipation, abdominal pain.
2. Urinary Symptoms: Frequent urination, excessive thirst.
3. Neurological Symptoms: Confusion, difficulty concentrating, fatigue, muscle weakness.
4. Bone and Joint Pain: Aches in bones and joints.
5. Cardiac Symptoms: Abnormal heart rhythms (arrhythmias), in severe cases.

It’s important to note that mild cases may not cause noticeable symptoms and are often detected incidentally through blood tests. Severe hypercalcemia can be a medical emergency requiring immediate treatment. If you suspect hypercalcemia based on symptoms or medical conditions, it’s essential to consult a healthcare provider for proper diagnosis and management.

What are the causes of hypercalcemia?

Hypercalcemia can occur due to various underlying conditions that affect calcium regulation in the body. Some common causes include:

1. Primary Hyperparathyroidism: This is the most common cause, where overactivity of the parathyroid glands leads to excess calcium release from bones into the blood.
2. Cancer: Certain cancers, especially those affecting the parathyroid gland, lung, breast, kidney, and multiple myeloma, can produce substances that raise calcium levels.
3. Medications: Some medications, such as thiazide diuretics (water pills), lithium (used for bipolar disorder), and excessive vitamin D or calcium supplements, can lead to hypercalcemia.
4. Vitamin D Disorders: Excessive intake of vitamin D or disorders that increase vitamin D production can lead to hypercalcemia.
5. Other Medical Conditions: Conditions such as sarcoidosis, tuberculosis, adrenal gland disorders (like Addison’s disease), and certain genetic disorders can disrupt calcium regulation.
6. Immobility: Prolonged immobility or bed rest can cause calcium to leave the bones and enter the bloodstream.
7. Kidney Disease: Severe kidney disease can impair the kidneys’ ability to excrete excess calcium, leading to hypercalcemia.
8. Hyperthyroidism: Overactive thyroid glands can indirectly lead to increased calcium levels.

Determining the specific cause of hypercalcemia usually requires blood tests, imaging studies, and sometimes biopsies to identify underlying conditions accurately. Treatment focuses on addressing the underlying cause and managing calcium levels to prevent complications.

How is the diagnosis of hypercalcemia made?

Diagnosis of hypercalcemia typically involves several steps to confirm the elevated calcium levels and determine the underlying cause. Here’s how it is usually diagnosed:

1. Blood Tests: The initial step involves measuring the total calcium levels in the blood. This includes both ionized calcium (the active form) and total calcium (which includes bound calcium).
2. Ionized Calcium Measurement: Sometimes, measuring ionized calcium directly can provide a more accurate assessment of calcium levels, especially in cases where albumin levels (which can affect total calcium levels) are abnormal.
3. Additional Blood Tests: Besides calcium levels, other blood tests may be conducted to assess kidney function (creatinine), parathyroid hormone (PTH) levels, vitamin D levels, and markers of bone turnover (such as alkaline phosphatase).
4. Urinary Tests: Urine calcium levels may be measured to assess how much calcium is being excreted by the kidneys.
5. Imaging Studies: Depending on the suspected cause, imaging tests such as ultrasound, CT scans, or MRI may be used to evaluate the parathyroid glands, kidneys, or other organs.
6. Bone Density Scan (DXA): This test may be done to evaluate bone density and assess for osteoporosis or bone loss related to hypercalcemia.
7. Clinical Evaluation: A thorough medical history and physical examination are important to identify symptoms, underlying medical conditions, medications, and potential risk factors contributing to hypercalcemia.

Once the diagnosis is established, further tests may be needed to determine the specific cause of hypercalcemia, which guides treatment and management decisions. It’s essential to consult with a healthcare provider or an endocrinologist for proper evaluation and management of hypercalcemia.

What is the treatment for hypercalcemia?

The treatment for hypercalcemia (elevated calcium levels in the blood) depends on the underlying cause of the condition. Here are some common treatments:

1. Intravenous fluids: Fluid therapy is often the first step in treating hypercalcemia. It helps to flush out excess calcium from the body and reduce its levels.
2. Calcitonin: A hormone that helps to lower calcium levels by reducing the amount of calcium released from bones and increasing its excretion in the urine.
3. Bisphosphonates: Medications like pamidronate (Aredia) or zoledronic acid (Zometa) can help to reduce calcium levels by inhibiting bone resorption and increasing bone density.
4. Steroids: Corticosteroids, such as prednisone, can help to reduce calcium levels by decreasing the production of parathyroid hormone (PTH), which regulates calcium levels.
5. Vitamin D receptor activators: Medications like calcitriol (Rocaltrol) can help to reduce calcium levels by blocking the action of vitamin D, which regulates calcium metabolism.
6. Loop diuretics: Medications like furosemide (Lasix) can help to increase urine production, which can help to remove excess calcium from the body.
7. Phosphate therapy: In severe cases, phosphate therapy may be used to lower calcium levels by promoting the excretion of calcium in the urine.

Surgical treatment may also be necessary in some cases:

1. Parathyroidectomy: Surgical removal of one or more parathyroid glands, which are responsible for producing PTH, may be necessary if hypercalcemia is caused by a parathyroid gland tumor or hyperplasia.
2. Calcitoninoma surgery: Surgical removal of a calcitonin-secreting tumor may be necessary if it is causing hypercalcemia.

It’s essential to note that treatment for hypercalcemia should only be initiated under the guidance of a healthcare provider, as each patient’s situation is unique and requires individualized care.

In addition to these treatments, lifestyle changes such as:

• Increasing fluid intake
• Avoiding foods high in phosphorus and calcium
• Limiting dairy products and processed foods
• Getting regular exercise

can also help manage hypercalcemia.

It’s crucial to work closely with a healthcare provider to determine the best course of treatment for your specific case of hypercalcemia.

What is the life expectancy of someone with hypercalcemia?

The life expectancy of someone with hypercalcemia (elevated calcium levels in the blood) can vary greatly depending on the underlying cause, severity, and effectiveness of treatment. Here are some general guidelines:

1. Mild hypercalcemia: If hypercalcemia is caused by a mild underlying condition, such as vitamin D toxicity or hypoparathyroidism, treatment can often lead to normal calcium levels and a normal life expectancy.
2. Moderate hypercalcemia: With moderate hypercalcemia caused by conditions like primary hyperparathyroidism or sarcoidosis, treatment can usually control symptoms and slow disease progression. Life expectancy may be slightly reduced, but most people with moderate hypercalcemia can expect to live a normal lifespan.
3. Severe hypercalcemia: In cases of severe hypercalcemia caused by conditions like advanced cancer, multiple myeloma, or severe parathyroid gland disorders, life expectancy is often significantly reduced. Without effective treatment, severe hypercalcemia can lead to:
   • Kidney failure
   • Cardiac arrhythmias
   • Respiratory failure
   • Seizures
   • Coma

In these cases, life expectancy is typically measured in weeks to months.

4. Untreated hypercalcemia: If left untreated, severe hypercalcemia can lead to rapid deterioration and death within a few days to weeks.

To give you a better idea, here are some general estimates of life expectancy based on the underlying cause of hypercalcemia:

• Primary hyperparathyroidism: 10-20 years
• Secondary hyperparathyroidism (e.g., kidney disease): 5-10 years
• Hyperparathyroidism due to cancer: 2-5 years
• Sarcoidosis: 10-20 years
• Vitamin D toxicity: variable, depending on the level of toxicity

Keep in mind that these are general estimates and may vary depending on individual circumstances. Treatment and management of hypercalcemia play a significant role in determining life expectancy.

It’s essential for individuals with hypercalcemia to work closely with their healthcare provider to develop a treatment plan that addresses their specific needs and underlying condition.