Download Clinical Manifestations of Hypercalcemia

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