Hypercalcemia

This morning we discussed an interesting case of hypercalcemia.

Key learning points included:

a) Patient confidentiality takes precedence over any legal issues the patient may have

b) Hypercalcemia: remember to ask about symptoms related to CAUSES and CONSEQUENCES. Most common causes are primary hyperparathyroidism (most common in incidental hypercalcemia and otherwise well outpatients), and malignancy (most common in sick inpatients).

A good way to classify etiology is:

Associated with high PTH:

- Primary, secondary, and tertiary hyperPTH

- Li ingesion

Associated with high vitD:

- Granulomatous disease (TB, sarcoid)

- Lymphoma

- Over-ingestion

Associated with normal vitD:

- Increased intake (milk alkali syndrome) - Decreased excretion (thiazides, familial hypocalciuric hypercalcemia)

- Increased bone turnover (hyperthyroidism, Paget's)

- Malignancy (PTHrP production, bony mets, osteoclast activation (in Myeloma))

Treatment is FLUIDS FLUIDS FLUIDS, IV bisphosphonate (watch in renal failure), calcitonin. Steroids may be a useful adjunct in non-TB granulomatous disease or known lymphoma.

Here's a great review article. Have a good weekend!