Chapter 26 Hypercalcemia Pathogenesis Clinical Manifestations Differential Diagnosis

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 PTHr. P 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 bisphonates • Glucocorticoids or dialysis if indicated ©American Society for Bone and Mineral Research Contributed by Elizabeth Shane and Dinaz Irani