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Chapter 26 Hypercalcemia: Pathogenesis, Clinical Manifestations, Differential Diagnosis, and Management © American Society for Bone and Mineral Research Contributed by Elizabeth Shane and Dinaz Irani Clinical Manifestations of Hypercalcemia •Mild hypercalcemia is usually asymptomatic •Moderate to severe hypercalcemia may present with: •Gastrointestinal – Nausea/vomiting, constipation, pancreatitis •Renal – polyuria, polydipsia, nephrogenic diabetes insipidus, nephrolithiaisis •Neuromuscular – depression, confusion, coma, muscle weakness •Cardiovascular – shortened QT interval, HTN, AV block •Other – shock, death © American Society for Bone and Mineral Research Contributed by Elizabeth Shane and Dinaz Irani Etiology of Hypercalcemia • 90% caused by primary hyperparathyroidism or malignancy • Primary hyperparathyroidism: • Hypercalcemia usually mild (within 1.0 mg/dl above upper limit of normal), and associated with elevated PTH levels • May be asymptomatic or show signs of chronic hypercalcemia (i.e. nephrolithiasis) • Malignant Disease: • Usually overtly ill • PTH levels usually low and PTHrP often elevated • Less common causes include other endocrine disorders (e.g., thyrotoxicosis, adrenal insufficiency), granulomatous diseases, medications, and renal failure © American Society for Bone and Mineral Research Contributed by Elizabeth Shane and Dinaz Irani Management of Hypercalcemia • Treat underlying cause if possible • Discontinue medications that may exacerbate the problem, mobilize patient as soon as possible • Saline hydration • Loop diuretic – If hypercalcemia is severe or patient has compromised cardiac or renal function – Use only after extracellular fluid volume has been restored • Calcitonin if rapid onset of action is desired • Intravenous bisphosphonates • Glucocorticoids or dialysis if indicated ©American Society for Bone and Mineral Research Contributed by Elizabeth Shane and Dinaz Irani