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Hypercalcemia: Causes, Symptoms, and Treatment

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Hypercalcemia, or higher than normal level of calcium in your blood, is a fairly common finding. Blood tests, such as those drawn for an annual physical exam, today routinely check calcium levels. This allows physicians to detect abnormally high calcium levels early.

Calcium is an important mineral in our bodies throughout our lifetime for bone growth, bone strength, maintaining proper hormone levels and optimal functioning of nerves, muscles and the brain. The calcium level is usually very carefully controlled by the body. However, certain medications and conditions can result in high blood calcium levels.

In the past, complications such as bone loss and fractures, kidney stones, kidney failure, hypertension and bradycardia (slowed heart rate), were commonly found as a result of longstanding untreated high calcium levels. These are now rarely seen thanks to blood tests that lead to preventive treatment.


What causes hypercalcemia?

Hypercalcemia can be caused by more than 25 separate diseases, several medications and even dehydration. Primary hyperparathyroidism and various kinds of cancers account for the greatest percentage of all patients with hypercalcemia.

In primary hyperparathyroidism, one or more of the four parathyroid glands, located behind the thyroid gland in your neck, produce too much parathyroid hormone. Normally, the parathyroid glands work with the kidneys, skeleton and intestines to carefully regulate the level of blood calcium. But sometimes a parathyroid gland becomes overactive, resulting in excess parathyroid hormone being released and an elevated blood calcium level.

Common medications such as hydrochlorothiazide and other thiazide diuretics (prescribed for hypertension and edema), lithium, and excessive intake of vitamin D, vitamin A or calcium can result in hypercalcemia. Taking too much calcium carbonate in the form of Tums® or Rolaids® is actually one of the more common causes of hypercalcemia.

Lung cancer, breast cancer and certain cancers of the blood can cause hypercalcemia that can become severe. Other less common causes of hypercalcemia include:

  • Lung diseases such as sarcoidosis and tuberculosis
  • Kidney failure
  • Hyperthyroidism (an overactive thyroid)
  • Being bedridden/immobilized, even for a relatively short period
  • Paget’s disease of the bone
  • Multiple myeloma

What are the symptoms of hypercalcemia?

Although having symptoms of hypercalcemia is uncommon, symptoms can include:

  • More frequent urination and thirst
  • Fatigue, bone pain, headaches
  • Nausea, vomiting, constipation, decrease in appetite
  • Forgetfulness
  • Lethargy, depression, memory loss or irritability
  • Muscle aches, weakness, cramping and/or twitches

How is hypercalcemia diagnosed?

Your doctor will order a blood test to determine if you have hypercalcemia. If the calcium is elevated, your physician will often review your medications and medical history as well as conduct a physical exam. If there is no obvious cause, your physician may ask you to see an endocrinologist, who will give you further evaluation and testing.

How is hypercalcemia treated?

Treatment of hypercalcemia depends on what is causing the disorder and how severe it is. 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

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.

How can hypercalcemia be prevented?

Not all hypercalcemia can be prevented, but avoiding excess intake of calcium pills and calcium-based antacid tablets is recommended. Be sure to talk with your doctor if you have a family history of high calcium, kidney stones or parathyroid conditions. Avoid taking dietary supplements, vitamins or minerals without first discussing them with your doctor.

What is the prognosis (outlook) for hypercalcemia?

Prognosis, like treatment, depends on the cause and severity of hypercalcemia. If the serum calcium is only slightly elevated, you will probably have few or no health complications.

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