Hypercalcemia

February 27, 2022ArticlesArrhythmiaKidney stonesOsteoporosis2

Hypercalcemia is a condition in which you have too high a concentration of calcium in your blood. Calcium is essential for the normal function of organs, cells, muscles, and nerves. It’s also important in blood clotting and bone health.
However, too much of it can cause problems. Hypercalcemia makes it hard for the body to carry out its normal functions. Too much calcium in your blood can weaken your bones, create kidney stones, and interfere with how your heart and brain work. Extremely high levels of calcium can be life-threatening.

Symptoms –
You might not have any noticeable symptoms if you have mild hypercalcemia. If you have a more serious case, you will typically have signs and symptoms that affect various parts of your body.

▪︎ General
•  headaches
•  fatigue

▪︎ Kidneys
Symptoms related to the kidneys include:
•  excessive thirst
•  excessive urination
•  pain between your back and upper abdomen on one side due to kidney stones

▪︎ Abdomen
Symptoms related to the abdomen include:
•  nausea
•  abdominal pain
•  decreased appetite
•  constipation
•  vomiting

▪︎ Heart
High calcium can affect the electrical system of the heart, causing abnormal heart rhythms.

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

▪︎ Skeletal system
High calcium levels can affect bones, leading to:
•  bone pain
•  osteoporosis
•  fractures from disease

▪︎ Neurological symptoms
Hypercalcemia can also cause neurological symptoms, such as depression, memory loss, and irritability. Severe cases can cause confusion and coma.

Causes –
Besides building strong bones and teeth, calcium helps muscles contract and nerves transmit signals. Normally, if there isn’t enough calcium in your blood, your parathyroid glands secrete a hormone that triggers:
•  Your bones to release calcium into your blood
•  Your digestive tract to absorb more calcium
•  Your kidneys to excrete less calcium and activate more vitamin D, which plays a vital role in calcium absorption

This delicate balance between too little calcium in your blood and hypercalcemia can be disrupted by a variety of factors. Hypercalcemia is caused by:
•  Overactive parathyroid glands (hyperparathyroidism).
This most common cause of hypercalcemia can stem from a small, noncancerous (benign) tumor or enlargement of one or more of the four parathyroid glands.
•  Cancer.
Lung cancer and breast cancer, as well as some blood cancers, can increase your risk of hypercalcemia. Spread of cancer (metastasis) to your bones also increases your risk.
•  Other diseases.
Certain diseases, such as tuberculosis and sarcoidosis, can raise blood levels of vitamin D, which stimulates your digestive tract to absorb more calcium.
•  Hereditary factors.
A rare genetic disorder known as familial hypocalciuric hypercalcemia causes an increase of calcium in your blood because of faulty calcium receptors in your body. This condition doesn’t cause symptoms or complications of hypercalcemia.
•  Immobility.
People who have a condition that causes them to spend a lot of time sitting or lying down can develop hypercalcemia. Over time, bones that don’t bear weight release calcium into the blood.
•  Severe dehydration.
A common cause of mild or transient hypercalcemia is dehydration. Having less fluid in your blood causes a rise in calcium concentrations.
•  Medications.
Certain drugs — such as lithium, used to treat bipolar disorder — might increase the release of parathyroid hormone.
•  Supplements.
Taking excessive amounts of calcium or vitamin D supplements over time can raise calcium levels in your blood above normal.

Complications –
Hypercalcemia complications can include:
•  Osteoporosis.
If your bones continue to release calcium into your blood, you can develop the bone-thinning disease osteoporosis, which could lead to bone fractures, spinal column curvature and loss of height.

•  Kidney stones.
 If your urine contains too much calcium, crystals might form in your kidneys. Over time, the crystals can combine to form kidney stones. Passing a stone can be extremely painful.
•  Kidney failure.
Severe hypercalcemia can damage your kidneys, limiting their ability to cleanse the blood and eliminate fluid.
•  Nervous system problems.
Severe hypercalcemia can lead to confusion, dementia and coma, which can be fatal.
•  Abnormal heart rhythm (arrhythmia).
Hypercalcemia can affect the electrical impulses that regulate your heartbeat, causing your heart to beat irregularly.

Diagnosis –
Your doctor can use blood tests to check the calcium level in your blood. Urine tests that measure calcium, protein, and other substances can also be helpful.
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
•  DEXA bone mineral density tests, which evaluate bone strength

Treatment –
Treatment of hypercalcemia depends on what is causing the disorder and how severe it is.
If your hypercalcemia is mild, you and your doctor might choose to watch and wait, monitoring your bones and kidneys over time to be sure they remain healthy.
Often the doctor may tell you calcium levels can be lowered if you:
•  Drink more water
•  Switch to a non-thiazide diuretic or blood pressure medicine
•  Stop calcium-rich antacid tablets
•  Stop calcium supplements
For more severe hypercalcemia, your doctor might recommend medications or treatment of the underlying disease, including surgery.
If the hypercalcemia is due to an overactive parathyroid gland, your doctor can consider several options:
•  Close monitoring of the calcium level
•  Referral to surgery to have the overactive gland(s) removed
•  Starting a medication such as cinacalcet (Sensipar®), which is used to manage hypercalcemia
•  Using bisphosphonates, osteoporosis drugs given intravenously (with a needle through the veins) that treat hypercalcemia due to cancer
•  Using denosumab (XGEVA®), another bone-strengthening drug for patients with cancer-caused hypercalcemia who don’t respond to bisphosphonates

If the hypercalcemia is severe, and/or causing significant symptoms, your doctor may recommend immediate hospitalization for intravenous fluids and other treatments.

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