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