Hypercalcemia – Diagnosis and Treatment
Diagnosis
Doctors use blood tests to find high calcium levels in the body. These tests measure total serum calcium and ionized calcium. Doctors also check parathyroid hormone (PTH) and vitamin D levels to find the cause.
If results confirm hypercalcemia, doctors may order medical imaging of the bones or lungs. Imaging can help find if a disease like cancer or another condition is causing the problem.
Key steps in diagnosis:
- Blood Tests: Total serum calcium and ionized calcium tests confirm elevated calcium levels. Measurement of PTH helps determine if the cause is parathyroid-related. Vitamin D levels and kidney function tests may also be checked.
- Parathyroid Hormone Evaluation: High PTH levels suggest primary hyperparathyroidism, while low PTH levels may point to cancer or other causes.
- Imaging Studies: Doctors may order X-rays, bone scans, chest CT scans, or lung imaging to detect tumors, bone lesions, or lung disease.
- Urine Tests: A 24-hour urine calcium test can help distinguish between primary hyperparathyroidism and familial hypocalciuric hypercalcemia (FHH).
- Additional Testing: In some cases, doctors may check thyroid function, perform protein electrophoresis to screen for multiple myeloma, or order further endocrine evaluations.
Timely and accurate diagnosis is crucial to identify underlying conditions and guide proper treatment to prevent complications like kidney stones, bone loss, or heart problems.
Treatment
Medicines
Several medicines help control high calcium in the body. These treatments lower blood calcium, relieve symptoms, and prevent organ damage.
Doctors may recommend one or more of the following:
| Medicine | Use | Common Side Effects |
|---|---|---|
| Hormone Therapy | Reduces blood calcium quickly. | Mild stomach upset |
| Calcimimetics | Manages overactive parathyroid glands. | Nausea, muscle cramps |
| Bisphosphonates | Quickly brings blood calcium down, used for cancer. | Thigh fractures, jaw bone issues |
| Monoclonal Antibody | Used if bisphosphonates are not effective. | Low calcium, skin infections |
| Steroids | Helps if high vitamin D causes the problem. | Weight gain, risk of infections |
1. Hormone Therapy: Doctors use calcitonin, made from salmon hormone, to lower blood calcium. They give it as an injection, and it acts quickly but may cause mild stomach pain.
2. Calcimimetics: Doctors prescribe these drugs to control the parathyroid glands. These medicines lower calcium in the blood by making the body think it has enough calcium.
3. Bisphosphonates: Doctors use bisphosphonates, especially when cancer causes high calcium. They give these drugs through a vein to slow bone breakdown and quickly reduce calcium. Sometimes, bones can weaken, and the jawbone may become damaged.
4. Monoclonal Antibody: Doctors use monoclonal antibody when bisphosphonates do not work. These drugs block cells that break down bone, lowering calcium levels.
5. Glucocorticoids (Steroids): Doctors may use steroids if too much vitamin D causes high calcium. Steroids lower both vitamin D and calcium but can cause swelling and raise infection risk.
6. Fluid Replacement and Diuretics: Very high calcium can be dangerous. Doctors give intravenous (IV) fluids to quickly remove extra calcium. If the body holds too much fluid, doctors use loop diuretics like furosemide to help remove it and lower calcium further. They use diuretics carefully to avoid dehydration.
7. Other Treatments: When standard drugs do not help, doctors may use dialysis. This is rare but important if kidneys are not working well.
Surgeries and Additional Interventions
When medicines are not enough, doctors may take other steps to control calcium levels.
Parathyroid Gland Removal
If one or more parathyroid glands work too hard and cause high calcium, surgeons can remove the problem gland or glands. Usually, only one of the four parathyroid glands is overactive.
Doctors use advanced imaging to find the gland causing trouble. They may use:
- Ultrasound
- Parathyroid Sestamibi Scans
- 4D CT scans
- Choline PET scans
After removing the overactive gland, most people see their calcium levels return to normal.
Other Hospital Treatments
In severe emergencies, doctors act fast to lower calcium. They may give large amounts of IV fluids and special medicines.
If kidneys are failing or very high calcium does not respond to standard care, doctors may use dialysis to quickly clear calcium from the blood.
Monitoring and Follow-Up
Some people do not need treatment right away, especially if their high calcium is mild and not causing symptoms. Doctors may watch their calcium levels and overall health regularly.
Bone and kidney checks often take place during this time.
Table: Procedures Used for Severe Hypercalcemia
| Procedure | When Used | Purpose |
|---|---|---|
| Parathyroid Removal | Overactive parathyroid glands | Cures the cause |
| IV Fluids | High or emergency calcium levels | Lowers calcium |
| Loop Diuretics | After fluids, if needed | Removes excess calcium/fluid |
| Dialysis | Severe cases, kidney failure | Rapid calcium removal |
Getting Ready for Your Visit
Steps You Can Take Beforehand
Being prepared can make your visit easier and help you get the care you need.
Here are some ways to get ready:
Write down all symptoms such as nausea, vomiting, constipation, muscle weakness, dehydration, weight loss, fatigue, fractures, or loss of appetite. Note how long each symptom has lasted and if it changes over time.
Gather your medical background. List past illnesses, surgeries, and any family history of high calcium, kidney stones, fractures, or genetic conditions.
Create a list of medications, vitamins, and supplements you take, including doses. This helps your doctor avoid dangerous interactions.
- Prepare questions in advance. For example:
- What could be causing symptoms such as abdominal pain, chest pain, or seizures?
- What tests will be needed?
- What treatments are available for hypercalcemia?
- Are there other options for treatment?
- How should co-existing health problems be handled?
Consider bringing support. Someone else can help remember what the doctor says and provide emotional support.
Quick Checklist Table
| Information to Bring | Why It’s Needed |
|---|---|
| List of symptoms | Helps identify and diagnose |
| Medication list | Avoids dangerous interactions |
| Family and personal history | Raises or lowers risk of certain causes |
| Questions for your doctor | Makes sure your concerns are addressed |
Questions Your Healthcare Provider May Ask
During your appointment, the doctor will discuss your symptoms and may ask:
- What symptoms are you experiencing, such as fatigue, frequent urination, appetite loss, stomach problems, or bone pain?
- When did the symptoms begin, and what makes them better or worse?
- Have you had recent fractures, kidney stones, muscle weakness, or seizures?
- Is there any family history of similar problems?
- Have you lost weight unintentionally or felt unusually dehydrated?
Your doctor may also ask about recent medical tests, treatments, your diet, and lifestyle. This information helps decide the next steps and which tests to order.
