Hypercalcemia: Causes, Symptoms, & Treatment
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Hypercalcemia

What Is Hypercalcemia?

Hypercalcemia is a condition in which you have too high a concentration of calcium in your blood. Calcium performs important functions, such as helping keep your bones healthy. However, too much of it can cause problems. Hypercalcemia makes it hard for calcium to carry out its normal functions.

What Are the Symptoms of Hypercalcemia?

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You might not have any symptoms if you have mild hypercalcemia. If you have a more serious case, you might have symptoms that affect various parts of your body.

Kidneys 

Symptoms related to your kidneys can lead to: 

  • excessive thirst
  • excessive urination
  • pain between your back and upper abdomen on one side

Abdomen 

Symptoms related to the abdomen include: 

  • nausea
  • abdominal pain
  • decreased appetite
  • constipation
  • vomiting

Muscles 

Calcium levels can affect your muscles, causing twitches and weakness.

Skeletal System 

High calcium levels can also cause bone issues, including: 

  • bone pain
  • height loss
  • bowed shoulders
  • curvature of the spine
  • fractures from disease 

Psychological Symptoms

Hypercalcemia can also cause psychological symptoms, such as depression, memory loss, and irritability. 

If you have cancer and experience any symptoms of hypercalcemia, call your doctor immediately. Hypercalcemia is a medical emergency in people who have cancer. 

What Causes Hypercalcemia?

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Your body regulates the calcium level in your blood through the parathyroid hormone (PTH), and another hormone called calcitonin. Normally, PTH increases when the calcium level in your blood falls and decreases when your calcium level rises. Your body also makes calcitonin when your calcium level gets too high. When you have hypercalcemia, your body can’t regulate your calcium level as it normally would. There are several possible causes of this condition.

Hyperparathyroidism

The parathyroid glands are four small glands near the thyroid gland in the neck. They regulate parathyroid hormone, which in turn regulates calcium in the blood. Hyperparathyroidism occurs when one or more of your parathyroid glands becomes overly active. This is the leading cause of hypercalcemia, especially in women over 50 years old. It occurs when the glands release too much PTH.

Lung Diseases and Cancers

Granulomatous diseases, such as tuberculosis, are lung diseases that can cause your vitamin D levels to rise. This causes more calcium absorption, which increases the calcium level in your blood. Some cancers, especially lung cancer, breast cancer, and blood cancers, can raise your risk for hypercalcemia.

Medication Side Effects

Some medications, particularly diuretics, can produce hypercalcemia. They do this by causing severe fluid diuresis, which is a loss of body water, and an underexcretion of calcium. This then leads to an excess concentration of calcium in the blood. Other drugs, such as lithium, cause more PTH to be released.

Dietary Supplements

Taking too much vitamin D or calcium in the form of supplements can raise your calcium level.

Dehydration

This usually leads to mild cases of hypercalcemia. Dehydration causes your calcium level to rise due to the low amount of fluid you have in your blood. 

How Is Hypercalcemia Diagnosed?

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Your doctor can use blood tests to check the calcium level in your blood. This is called a serum calcium test. If your doctor finds a high calcium level, they’ll order more tests to find out the cause of your condition. Blood tests can help your doctor diagnose hyperparathyroidism. Tests that can allow your doctor to check for evidence of cancer or other diseases that can cause hypercalcemia include: 

  • chest X-rays, which can reveal lung cancer
  • mammograms, which help diagnose breast cancer
  • CT scans, which form a more detailed image of your body
  • MRI scans, which produce detailed images of your body’s organs and other structures

What Are the Treatment Options for Hypercalcemia?

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Mild Cases

If you have mild hypercalcemia, your doctor might suggest simply keeping track of your condition and waiting to see if it improves or gets worse on its own.

Severe Cases

You might need hospital treatment if you have a severe case. The goal of treatment is to return your calcium level to normal. Treatment also aims to prevent damage to your bones and kidneys. Treatment options include the following:

  • Calcitonin is a hormone produced in the thyroid gland. It slows down bone loss.
  • Intravenous fluids keep you hydrated.
  • Corticosteroids are anti-inflammatory medications. They help your body handle having too much vitamin D.
  • Loop diuretic medications can help your kidneys function and get rid of extra calcium.
  • Intravenous bisphosphonates can keep your bones from breaking down.
  • Dialysis can be given to rid your blood of extra calcium and waste when you have damaged kidneys. This is only done if other treatment methods aren’t working.

Primary Hyperparathyroidism 

If you have kidney stones or bone loss due to this condition, you might need surgery to remove the abnormal parathyroid glands. This procedure cures most cases of hypercalcemia caused by hyperparathyroidism. If surgery isn’t an option for you, your doctor might give you a medication called cinacalcet. This lowers your calcium level by decreasing PTH production. If you have osteoporosis, your doctor might have you take bisphosphonates to lower your risk of fractures.

Cancer 

If you have cancer, your doctor will discuss treatment options with you to help you determine if you want to treat hypercalcemia. You might be able to get relief from symptoms through intravenous fluids and medications. This might make it easier for you to deal with your cancer treatments.

What Are the Complications Associated with Hypercalcemia?

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Severe cases of hypercalcemia can cause kidney problems, such as kidney stones and kidney failure. Other complications include irregular heartbeats and osteoporosis. Hypercalcemia can also cause confusion or dementia since calcium helps keep your nervous system functioning properly. Serious cases can lead to a potentially life-threatening coma.

What Is the Long-Term Outlook?

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Your long-term outlook will depend on the how severe your condition is. Your doctor can determine the best treatment for you. Talk to your doctor regularly to stay informed and ask questions.

You can protect your kidneys and bones from damage due to hypercalcemia by adopting a healthier lifestyle. Make sure you drink plenty of water. This can keep kidney stones from developing. Since smoking can speed up bone loss, it’s important to quit as soon as possible. Smoking also causes many other health issues. Quitting smoking can only help your health. 

Do a combination of weight-bearing exercises and strength training to keep your bones strong and healthy. Talk to your doctor first to find out what types of exercises are safe for you. This is especially important if you have cancer that affects your bones.

You Asked, We Answered

  • What precautions should I take if I think I may be at risk for hypercalcemia?
  • There are several proactive steps you can take. You should stay adequately hydrated by drinking the proper amount of fluids, including water. You should also consume the proper amount of salt in your diet, which comes out to about 2,000 milligrams of sodium per day for the typical adult. Finally, talk to your doctor to see whether any of your current prescription or over-the-counter medications might be raising your risk of developing hypercalcemia.

    - Steve Kim, MD

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