Hypercalcemia Health Article

Definition

Hypercalcemia is an abnormally high level of calcium in the blood, usually more than 10.5 milligrams per deciliter of blood.

Description

Calcium plays an important role in the development and maintenance of bones in the body. It is also needed in tooth formation and is important in other body functions. Normally, the body maintains a balance between the amount of calcium in food sources and the calcium already available in the body's tissues. The balance can be upset if excess amounts of calcium are eaten or if the body is unable to process the mineral because of disease.

Calcium is one of the most important and most abundant minerals in the human body. Dairy products are the major source of calcium. Eggs, green leafy vegetables, broccoli, legumes, nuts, and whole grains provide smaller amounts. Only about 10–30% of the calcium in food is absorbed into the body. Most calcium is found in combination with other dietary components and must be broken down by the digestive system before it can be used. Calcium is absorbed into the body in the small intestine. Its absorption is influenced by such factors as the amount of vitamin D hormone available to aid the process and the levels of calcium already present in the body. As much as 99% of the body's calcium is stored in bone tissue. A healthy person experiences a constant turnover of calcium as bone tissue is built and reshaped. The remaining 1% of the body's calcium circulates in the blood and other body fluids. Circulating calcium plays an important role in the control of many body functions, such as blood clotting, transmission of nerve impulses, muscle contraction, and other metabolic activities. In the bloodstream, calcium maintains a constant balance with another mineral, phosphate.

Two main control agents are vital in maintaining calcium levels, vitamin D hormone and parathyroid hormone. A hormone is a chemical substance that is formed in one organ or part of the body and carried in the blood to another organ. It can alter the function, and sometimes the structure, of one or more organs.

• Parathyroid hormone (PTH). The four parathyroid glands are endocrine glands located next to the thyroid gland in the neck. A gland is a cell or group of cells that produces a material substance (secretion). When the level of calcium circulating in the blood drops, the parathyroid gland releases its hormone. PTH then acts in three ways to restore the normal blood calcium level. It stimulates the absorption of more calcium in the intestine; it takes more calcium from the bone tissue, and it causes the kidneys to excrete more phosphate.
• Vitamin D hormone. This hormone works with parathyroid hormone to control calcium absorption and affects the deposit of calcium and phosphate in the bone tissue.

The kidneys also help to control calcium levels. Healthy kidneys can increase calcium excretion almost fivefold to maintain normal concentrations in the body. Hypercalcemia can occur when the concentration of calcium over-whelms the ability of the kidneys to maintain balance.

Causes of hypercalcemia

Many different conditions can cause hypercalcemia; the most common are hyperparathyroidism and cancer.

PRIMARY HYPERPARATHYROIDISM. Primary hyperparathyroidism is the excessive secretion of parathyroid hormone by one or more of the parathyroid glands. It is the most common cause of hypercalcemia in the general population. Women have this condition more frequently than men do, and it is more common in older people. It can appear thirty or more years after radiation treatments to the neck. Ninety percent of the cases of primary hyperparathyroidism are caused by a non-malignant growth on the gland.

Hyperparathyroidism can also occur as part of a rare hereditary disease called multiple endocrine neoplasia. In this disease, tumors develop on the parathyroid gland.

CANCER. People with cancer often have hypercalcemia. In fact, it is the most common life-threatening metabolic disorder associated with cancer. Ten to twenty percent of all persons with cancer have hypercalcemia. Cancers of the breast, lung, head and neck, and kidney are frequently associated with hypercalcemia. It also occurs frequently in association with certain cancers of the blood, particularly malignant myeloma. It is seen most often in patients with tumors of the lung (25–35%) and breast (20–40%), according to the National Cancer Institute. Cancer causes hypercalcemia in two ways. When a tumor grows into the bone, it destroys bony tissue (osteolysis). When the bone is not involved, factors secreted by cancer cells can increase calcium levels (humoral hypercalcemia of malignancy). The two mechanisms may operate at the same time.

Because immobility causes an increase in the loss of calcium from bone, cancer patients who are weak and spend most of their time in bed are more prone to hypercalcemia. Cancer patients are often dehydrated because they take in inadequate amounts of food and fluids and often suffer from nausea and vomiting. Dehydration reduces the ability of the kidneys to remove excess calcium from the body. Hormones and diuretics that increase the amount of fluid released by the body can also trigger hypercalcemia.

OTHER CAUSES. Other conditions can cause hypercalcemia. Excessive intake of vitamin D increases intestinal absorption of calcium. During therapy for peptic ulcers, abnormally high amounts of calcium antacids are sometimes taken. Overuse of antacids can cause milk-alkali syndrome and hypercalcemia. Diseases such as Paget's, in which bone is destroyed or reabsorbed, can also cause hypercalcemia. As in cancer or paralysis of the arms and legs, any condition in which the patient is immobilized for long periods of time can lead to hypercalcemia due to bone loss.