Hypercalcemia (Elevated Calcium Levels)

  • Medical Author:
    Ruchi Mathur, MD, FRCP(C)

    Ruchi Mathur, MD, FRCP(C) is an Attending Physician with the Division of Endocrinology, Diabetes and Metabolism and Associate Director of Clinical Research, Recruitment and Phenotyping with the Center for Androgen Related Disorders, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Hypercalcemia facts

  • Calcium is important for bone strength, as well as muscle and nerve function
  • Calcium levels in the bloodstream are regulated by PTH, vitamin D, and calcitonin
  • Hypercalcemia can vary in severity and in chronicity
  • The main cause of hypercalcemia is hyperparathyroidism
  • Malignancies may be associated with hypercalcemia, and the presence of hypercalcemia usually heralds a worse prognosis
  • The signs and symptoms of hypercalcemia can be remembered by the phrase "moans, stones, groans, and bones."
  • Treatment depends on the underlying cause of hypercalcemia as well as the degree of severity
  • Both surgical and medical treatments are available as treatment options
  • Prognosis depends on the underlying cause of hypercalcemia

Hypercalcemia Introduction

Calcium is a mineral that is important in the regulation and processes of many body functions including bone formation, hormone release, muscle contraction, and nerve and brain function. Hypercalcemia is the term that refers to elevated levels of calcium in the bloodstream.

Regulation of Calcium

Calcium levels are tightly regulated in the body. Calcium regulation is primarily controlled by parathyroid hormone (PTH), vitamin D, and calcitonin.

  • Parathyroid hormone is a hormone produced by the parathyroid glands, which are four small glands that surround the thyroid and are found in the anterior part of the lower neck.
  • Vitamin D is obtained through a process that begins with sun exposure to the skin, the process then continues in the liver and kidneys. Vitamin D can also be found in foods such as eggs and dairy products.
  • Calcitonin is produced in specialized cells in the thyroid gland.

Together, these three hormones act on the bones, the kidneys, and the GI tract to regulate calcium levels in the bloodstream.

Picture of the Parathyroid Glands
Picture of the Parathyroid Glands
Not all calcium supplements are the same, and taking too many calcium supplements can lead to hypercalcemia.

Calcium Supplements: Not All Are Equal

Author: Betty Kovacs, MS, RD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

Viewer Question: I've heard that not all calcium supplements are the same. Which over-the-counter vitamins or minerals help build bones? Which brands or types are better than others?

Dietician's Response: You heard right, not all calcium supplementsare the same. The supplements will differ by the kinds of calcium that they contain, the amount that they contain, and any thing else that is added to them (other minerals or vitamins). Along with that, there are other factors that will affect how much of the calcium you will actually absorb, including medications that you are taking, your age, your vitamin D levels, the amount of calcium that you are taking and if you are pregnant. If you have any concerns over any of these, it would be best to speak with your physician before taking anything.

The most common forms of calcium in supplements are calcium carbonateand calcium citrate. The differences between the two are...

What are the causes of hypercalcemia?

One of the most common causes of high calcium levels (hypercalcemia), is an overproduction of parathyroid hormone, or hyperparathyroidism.

  • Hyperparathyroidism tends to be more common in women over 50.
  • It can be the result of all four parathyroid glands producing too much PTH (parathyroid hyperplasia), or one gland specifically producing an excessive amount of hormone (usually the result of a parathyroid adenoma, or benign tumor).

Hypercalcemia can occur due to other medical conditions. These conditions can vary in severity and chronicity, and may be life-threatening. Malignancy is a common cause of elevated blood calcium. Up to 20% of individuals with cancer will develop hypercalcemia at some point in their disease.

Other conditions associated with hypercalcemia include:

What are the signs and symptoms of hypercalcemia?

In the majority of patients with hypercalcemia, the signs and symptoms are minimal. In general, the symptoms increase with higher levels of calcium in the blood. In severe cases, the elevated calcium levels can cause abnormal heart rhythms with specific findings on electrocardiogram (EKG).

Because of the clinical findings that are seen in hypercalcemia, the symptoms are often described as "moans, stones, groans, and bones".

Some of the symptoms include the following:

Moans (gastrointestinal conditions)

Stones (kidney-related conditions)

Groans (psychological conditions)

Bones (bone pain and bone-related conditions)

  • Bone aches and pains
  • Fractures
  • Curving of the spine and loss of height

How is hypercalcemia diagnosed?

Hypercalcemia is easily diagnosed with a blood test. Diagnosing the causes of hypercalcemia, however, is a more involved process; in addition to a detailed history and physical examination, it may require further blood tests (such as a PTH level and vitamin D level), urine evaluation, X-rays, and other imaging procedures.

How is hypercalcemia treated?

The treatment of elevated levels of calcium in the blood involves the evaluation of the following:

  1. Is the level of calcium elevated enough to be dangerous, or is it causing symptoms?
  2. What is the underlying cause of the hypercalcemia, and does it need treatment?

If the hypercalcemia is causing severe symptoms, or if the values are critically high, lowering the blood levels may require hospitalization and the use of hydration, steroids, or even dialysis. There are intravenous medications that can be used to lower calcium as well.

If the hypercalcemia is modest, treatment with medications can be administered on an outpatient basis.

If the underlying cause is hyperparathyroidism (particularly from an adenoma), there are certain criteria that are reviewed to discuss if surgery should be considered. These criteria include the absolute calcium level, a history of kidney stones or other calcium-related complications, and the amount of calcium seen in a 24-hour urine collection. Based on these findings, surgical removal of the adenoma may be considered.

What is the prognosis for hypercalcemia?

The results of treatment for hypercalcemia depend on the underlying cause of the condition. If hypercalcemia is seen in the presence of cancer, the average 30-day survival rate is about 50%. The prognosis is excellent for many of the other causes of hypercalcemia provided the underlying cause is addressed and treated.

Can hypercalcemia be prevented?

Hypercalcemia cannot be prevented, but early detection can both allow for normalization of calcium levels and lead to an early work-up to define the cause. If there is a known family history of hypercalcemia or hyperparathyroidism, it is worth mentioning this to the health care practitioner; together the patient and health care practitioner can determine if screening is warranted.

Medically reviewed by John A. Seibel, MD; Board Certified Internal Medicine with a subspecialty in Endocrinology & Metabolism

REFERENCES:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931619/
http://www.cancer.gov/cancertopics/pdq/supportivecare/hypercalcemia/HealthProfessional

Last Editorial Review: 8/5/2016

Reviewed on 8/5/2016
References
Medically reviewed by John A. Seibel, MD; Board Certified Internal Medicine with a subspecialty in Endocrinology & Metabolism

REFERENCES:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931619/
http://www.cancer.gov/cancertopics/pdq/supportivecare/hypercalcemia/HealthProfessional

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