Hypercalcemia

Hypercalcemia


HYPERCALCEMIA

  • Hypercalcemia is when total serum calcium value is above the upper limit of the normal range or an elevated ionized calcium value.

 Etiology-

I) With normal or elevated PTH levels-

  1. Primary or tertiary hyperparathyroidism (most common)
  2. Li- induced hyperparathyroidism
  3. Familial hypocalciuric hypercalcemia

II) With low PTH levels-

  1. Malignancy (most common)
  2. Elevated 1, 25 (OH)2 vitamin D
  3. Thyrotoxicosis, sarcoidosis, bone metastasis, multiple myeloma
  4. Paget’s disease with immobilisation
  5. Milk- alkali syndrome
  6. Thiazide diuretics
  7. Glucocorticoids deficiency

Clinical features-

  • General- anorexia, fatigue, nausea, pancreatitis
  • Renal- polyuria, polydipsia, renal stones
  • GIT- dyspepsia, peptic ulcer, constipation
  • CNS- impaired cognition, hypertension
  • Metabolic- metastaticcalcification, bone pain, fracture, nephrocalcinosis

 Investigations-

  • Most common investigation is serum PTH level.
  • PTH increased- primary hyperparathyroidism
  • High plasma phosphate & alkali phosphatise- tertiary hyperparathyroidism
  • Low urine calcium excretion- FHH
  • Tests used to distinguish Primary Hyperparathyroidsm from Familial Benign Hypercalcemia- urinary calcium levels
  • Hypercalcemia in ECG is diagnosed by decreased QT interval.

Treatment-

  • Volume expansion- 4-6 lt. Intravenous saline
  • Hypercalcemia of malignancy – Zoledronic acid, pamidronate
  • 1, 25 (OH)2 D mediated hypercalcemia- glucocorticoids
  • Calcitonin- for life threatening hypercalcemia
  • Bisphosphonates- decreased serum calcium

Exam Important

 Etiology-

I) With normal or elevated PTH levels-

  1. Primary or tertiary hyperparathyroidism (most common)
  2. Li- induced hyperparathyroidism
  3. Familial hypocalciuric hypercalcemia

II) With low PTH levels-

  1. Malignancy (most common)
  2. Elevated 1, 25 (OH)2 vitamin D
  3. Thyrotoxicosis, sarcoidosis, bone metastasis, multiple myeloma
  4. Paget’s disease with immobilisation
  5. Milk- alkali syndrome
  6. Thiazide diuretics
  7. Glucocorticoids deficiency

Etiology-

  1. With normal or elevated PTH levels-
  2. Primary or tertiary hyperparathyroidism (most common)
  3. Li- induced hyperparathyroidism
  4. Familial hypocalciuric hypercalcemia

II) With low PTH levels-

  1. Malignancy (most common)
  2. Elevated 1, 25 (OH)2 vitamin D
  3. Thyrotoxicosis, sarcoidosis, bone metastasis, multiple myeloma
  4. Paget’s disease with immobilisation
  5. Milk- alkali syndrome
  6. Thiazide diuretics
  7. Glucocorticoids deficiency

Clinical features-

  • General- anorexia, fatigue, nausea, pancreatitis
  • Renal- polyuria, polydipsia, renal stones
  • GIT- dyspepsia, peptic ulcer, constipation
  • CNS- impaired cognition, hypertension
  • Metabolic- metastaticcalcification, bone pain, fracture, nephrocalcinosis

 Investigations-

  • Most common investigation is serum PTH level.
  • PTH increased- primary hyperparathyroidism
  • High plasma phosphate & alkali phosphatise- tertiary hyperparathyroidism
  • Low urine calcium excretion- FHH
  • Tests used to distinguish Primary Hyperparathyroidsm from Familial Benign Hypercalcemia- urinary calcium levels
  • Hypercalcemia in ECG is diagnosed by decreased QT interval.

Treatment-

  • Volume expansion- 4-6 lt. Intravenous saline
  • Hypercalcemia of malignancy – Zoledronic acid, pamidronate
  • 1, 25 (OH)2 D mediated hypercalcemia- glucocorticoids
  • Calcitonin- for life threatening hypercalcemia
  • Bisphosphonates- decreased serum calcium
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