Hypercalcemia

February 8, 2017

Hypercalcemia is an elevated calcium level in the blood. Hypercalcemia can be asymptomatic in laboratory results, but high calcium levels are often an indicator of multiple myeloma. Hypercalcemia related to multiple myeloma is caused by the breakdown of bone which leads to the release of calcium into the blood. This can be a serious problem if appropriate treatment is not given immediately. Severe hypercalcemia can result in coma or cardiac arrest.

Hypercalcemia develops in 10%–20% of adults with cancer, but it rarely develops in children. When it develops in people with cancer, it may be called hypercalcemia of malignancy (HCM)

Calcium enters the blood in different ways. The level of calcium in the blood is controlled by hormones and the kidneys.

Calcitriol is a hormone form of vitamin D. It helps the intestines take up calcium from foods and drinks. The intestines then release calcium into the blood. Parathyroid hormone (PTH) helps control the level of calcium in the blood. When blood calcium levels are low, the parathyroid gland releases PTH. PTH stimulates cells in the bones to break bone down and release calcium into the blood. It also tells the kidneys and intestines to absorb more calcium. The kidneys help control the amount of calcium in the body. They can remove large amounts of calcium from the blood and pass it into the urine.

Severe hypercalcemia can have serious consequences, including kidney damage, dementia, and coma. Treating the underlying disorder is often sufficient to restore blood levels of calcium to normal. However, some of the problems associated with severe hypercalcemia are irreversible.

Causes

Calcium is important to many body functions, including –

Bone formation
Hormone release
Muscle contraction
Nerve and brain function

Parathyroid hormone (PTH) and Vitamin D help manage calcium balance in the body. PTH is made by the parathyroid glands, which are four small glands located in the neck behind the thyroid gland. Vitamin D is obtained when the skin is exposed to sunlight, and from dietary sources such as –

Egg yolks
Fish
Fortified cereals
Fortified dairy products

Primary hyperparathyroidism is the most common cause of hypercalcemia. It is due to excess PTH release by the parathyroid glands. This excess occurs due to an enlargement of one or more of the parathyroid glands, or a growth on one of the glands. (Most of the time, these growths are not cancerous).

Other conditions can also cause hypercalcemia –

An inherited condition that affects the body’s ability to regulate calcium (familial hypocalciuric hypercalcemia)
Being bed-bound (or not being able to move) for a long period of time (this occurs most often in young people)
Calcium excess in the diet. This is called milk-alkali syndrome. It is most often due to at least 2,000 milligrams of calcium per day. Taking too much vitamin D may add to the problem.
Hyperthyroidism
Kidney failure
Medications such as lithium and thiazide diuretics (water pills)
Some cancerous tumors (for example, lung cancers, breast cancer)
Some infectious and inflammatory diseases such as tuberculosis, Paget’s disease and sarcoidosis

Women in their 50s are the population at highest risk of overactive parathyroid glands.

Symptoms

The symptoms of hypercalcemia often develop slowly and may be similar to the symptoms of cancer or cancer treatment. How serious a person’s symptoms are is not related to the calcium level in the blood. Many patients have no symptoms. And, older patients usually experience more symptoms than younger patients.

People with hypercalcemia may experience the following symptoms –

Loss of appetite
Nausea and vomiting
Constipation and abdominal pain
Increased thirst and frequent urination
Fatigue, weakness, and muscle pain
Confusion, disorientation, and difficulty thinking
Headaches
Depression

Symptoms of severe hypercalcemia may include –

Kidney stones, a painful condition in which salt and minerals form solid masses called stones in the kidneys or urinary tract
Irregular heartbeat
Heart attack
Loss of consciousness
Coma

Patients and their families should be familiar with the symptoms on this list. Relieving side effects is an important part of cancer care and treatment. This is called palliative care. Talk with your health care team about any symptoms or side effects you may experience. This includes any new symptoms or a change in symptoms.

Complications

Pancreatitis
Peptic ulcer disease
Calcium deposits in the kidney (nephrocalcinosis)
Dehydration
High blood pressure
Kidney failure
Kidney stones
Depression
Difficulty concentrating or thinking
Bone cysts
Fractures
Osteoporosis

These complications of long-term hypercalcemia are uncommon today.

Treatment

Removal of the abnormal and hyperfunctioning parathyroid tissue results in a long-term cure of HPT in 96% of patients and significant improvement in associated symptoms. The following criteria were proposed as indications for parathyroidectomy based on a National Institutes of Health–sponsored panel and endocrine specialty societies –

Serum Ca level more than 1 mg/dL above the upper limit of normal
Marked hypercalciuria higher than 400 mg/day
Creatinine clearance reduced more than 30% compared with age-matched controls
Reduction in bone mineral density of the femoral neck, lumbar spine, or distal radius of more than 2.5 standard deviations below peak bone mass (T score lower than -2.5)
Age younger than 50 years
Patients for whom medical surveillance is not desirable or possible
Presence of any complications (e.g., nephrolithiasis, overt bone disease)
An episode of hypercalcemic crisis

Medications – In some cases, the doctor may recommend:

Calcimimetics – This type of drug mimics calcium circulating in the blood, so it can help control overactive parathyroid glands.

Bisphosphonates – Intravenous osteoporosis drugs can help rebuild bone weakened by hypercalcemia. Risks associated with this treatment include osteonecrosis of the jaw and certain types of thigh fractures.

Prednisone – If the hypercalcemia is caused by high levels of vitamin D, short-term use of steroid pills such as prednisone might be helpful.

IV fluids and diuretics – Extremely high calcium levels can be a medical emergency. Hospitalization for treatment with IV fluids and diuretics to promptly lower the calcium level may be needed to prevent heart rhythm problems or damage to the nervous system.

Dialysis – If the kidneys fail due to cancer or its treatment, you may need dialysis. Dialysis removes wastes from the blood when the kidneys don’t work properly.

Alternative Treatment

Probiotics – Vitamin K2 (menaquinone) is one of many vitamins that probiotic microbes make in the digestive tract. If the bacteria in the gut are out of balance, people may be deficient in K2 and several other B vitamins. A deficiency of vitamin K2 causes deposition of calcium on the artery walls and atherosclerosis.
Drink plenty of fluids, especially water – Drinking fluids can help keep the person from dehydration and help prevent kidney stones from forming.
Exercise – Once the calcium levels return to normal, and if the person is otherwise healthy, it’s important to remain active to help maintain bone density. Try to combine strength training with weight-bearing exercises.
Don’t smoke – Smoking has been shown to increase bone loss as well as dramatically increase the risk of a number of serious health problems.

Reference –

http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/managing-side-effects/increased-intracranial-pressure-icp/?region=on

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.457.692&rep=rep1&type=pdf\

http://www.mayoclinic.org/diseases-conditions/hypercalcemia/basics/treatment/con-20031513

http://www.globalhealingcenter.com/natural-health/what-is-calcium-toxicity-and-hypercalcemia/

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.457.692&rep=rep1&type=pdf\

http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0009/36945/aaa_Hypercalcaemia_FINAL_021111.pdf

https://www.endocrinology.org/policy/docs/13-02_EmergencyGuidance-AcuteHypercalcaemia.pdf

http://www.healthcommunities.com/blood-disorders/what-is-hypercalcemia.shtml

https://umm.edu/health/medical/ency/articles/hypercalcemia

http://www.merriam-webster.com/dictionary/hypercalcemia

http://www.medicinenet.com/hypercalcemia/article.htm