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Hypercalcemia

See also: calcium as a mineral and calcium in diet


Hypercalcemia
Other namesHypercalcaemia
Medical specialtyEndocrinology
SymptomsAbdominal pain, bone pain, confusion, depression, weakness[1][2]
ComplicationsKidney stones, abnormal heart rhythm, cardiac arrest[1][2][3] Diagnosis should generally include either a corrected calcium or ionized calcium level and be confirmed after a week.[1]
CausesPrimary hyperparathyroidism, cancer, sarcoidosis, tuberculosis, Paget disease, multiple endocrine neoplasia, vitamin D toxicity[1][3]
Diagnostic methodBlood serum level (more than) > 2.6 mmol/L (corrected calcium or ionized calcium)[1][2]
PreventionHealthy diet, supplements
TreatmentUnderlying cause, intravenous fluids, furosemide, calcitonin, pamidronate, hemodialysis[1][2]
Frequency4 per 1,000[1]

Hypercalcemia (also spelled hypercalcaemia) is too much calcium in the blood serum. It is usually caused by either cancer or parathyroid disease.[4] It is rare in healthy people. It is the opposite of hypocalcemia, which is too low calcium blood content. Usually, people can enough calcium from a healthy, balanced diet, and calcium supplements are usually the cause of hypercalcemia.

The Oxford Clinical Handbook of Medicine introduces hypercalcemia as 'stones, bones, and psychic moans' because of the symptoms that it can cause.[5] Hypercalcemia can cause bones to form out of control, or ectopically (out of place). It also might cause some mental illness as well as bone pain.

Symptoms

If hypercalcemia is severe, it may cause changes in mental status and cause mental illness.[4] It can cause confusion, depression, and anxiety.[5] It can also cause poor muscle tone (hypotonia), hypophosphatemia (low phosphates in the blood), and for the kidneys (renal) to not work properly.[4][5] It can cause pyrexia (rash). Other symptoms can include nausea, abdominal pain, constipation, weight loss.[6] Mentally, it can also cause tiredness, confusion, and weakness.

It can cause polyuria (urinating too much) and thirst.[4] Hypercalcemia can cause low blood pressure (hypertension), and problems with the heart like cardiac arrest (the heart stopping) and shortened QT interval. It is linked to (associated with) increased in mortality (death) from cardiovascular disease (also called CVD).

Hypercalcemia can cause heart arrythmias. It can be associated with Sarcoidosis[7][5] or Tuberculosis.Calcium can be deposited (put) in places in the body that it should not be when there is too much. In this case, it can go to the eyes and be deposited and shows at a horizontal grey-white band in the eye (across the central cornea) between the eyelids (also called the interpalpebral zone). When this change happens, it is called band keratopathy, which is also called calcific band keratopathy.[8]

Cause

Hypercalcemia is often caused by malignancy (when the cell growth becomes benign or goes out of hand), for example in bone metastases, myeloma, or related to the parathyroid gland. The parathyroid hormone-related protein (PTHrP) works to balance calcium metabolism (called calcium homeostasis) and works closely with calcium, for example by moving it in or out of bones. When the parathyroid hormone-related proteins go out of check for too long, it can cause hypercalcaemia.[5] Primary hyperparathyroidism (the parathyroid gland working too much) can cause hypercalcemia.[5] Other causes not as common as malignancy include tertiary hyperparathyroidism, thyrotoxicosis, milk-alkali syndrome (a metabolic disorder).[5]

Causes of hypercalcemia not related to malignancy include vitamin D intoxication[5] (having too much vitamin D) and certain medications. For example, lithium (for treating bipolar disorder) can cause hypercalcemia.[5] Rarely, so can familial benign hypocalciuric hyperaemia (a defect in the calcium sensing receptors).[5] Sarcoidosis is another cause of hypercalcemia. HIV (like HIV/AIDS) can cause the levels of calcium in the blood to go down (which scientists think is from the parathyroid hormone related bone remodelling).[5]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Minisola, S; Pepe, J; Piemonte, S; Cipriani, C (2015). "The diagnosis and management of hypercalcaemia". BMJ. 350 h2723. doi:10.1136/bmj.h2723. PMID 26037642. S2CID 28462200.
  2. ↑ 2.0 2.1 2.2 2.3 Soar, Jasmeet; Perkins, Gavin D; Abbas, Gamal; Alfonzo, Annette; Barelli, Alessandro; Bierens, Joost J.L.M; Brugger, Hermann; Deakin, Charles D; Dunning, Joel; Georgiou, Marios; Handley, Anthony J; Lockey, David J; Paal, Peter; Sandroni, Claudio; Thies, Karl-Christian; Zideman, David A; Nolan, Jerry P (2010). "European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution". Resuscitation. 81 (10): 1400–33. doi:10.1016/j.resuscitation.2010.08.015. PMID 20956045.
  3. ↑ 3.0 3.1 "Hypercalcemia - National Library of Medicine". PubMed Health. Archived from the original on 8 September 2017. Retrieved 27 September 2016.
  4. ↑ 4.0 4.1 4.2 4.3 "Office of Dietary Supplements - Calcium". ods.od.nih.gov. Retrieved 2026-04-12.
  5. ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 Longmore, J. M.; Wilkinson, Ian; Baldwin, Andrew; Wallin, Elizabeth (2015). Oxford handbook of clinical medicine (Ninth edition ed.). Oxford ; New York: Oxford University Press. ISBN 978-0-19-872254-0. {{cite book}}: |edition= has extra text (help)
  6. ↑ "Hypercalcemia - Symptoms and causes". Mayo Clinic.
  7. ↑ "UpToDate". www.uptodate.com.
  8. ↑ "Eye Surgery Band Keratopathy". eyesurgeryinberkshire.co.uk. Retrieved 2026-04-15.


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