Hypercalcemia
Hypercalcemia is defined as total calcium >10.5 mg/dL. Hypercalcemia occurs when the resorption rate of bone mineral or the absorption of intestinal calcium exceeds the renal excretory capacity for calcium or when there is increased renal tubular absorption of calcium. Symptoms are nonspecific and do not usually develop until calcium is >14 mg/dL.
Differential Diagnosis
- Hyperparathyroidism
–Primary
–Familial (MEN types 1 and 2A)
–Familial (MEN types 1 and 2A)
–Most common endocrinopathy in
children with MEN 1
–PTH-secreting adenoma
–Secondary/tertiary
–Following renal transplantation
–Chronic hyperphosphatemia
-
Familial hypocalciuric hypercalcemia (FHH)
-
Vitamin D excess
–Nutritional excess
–Inflammatory/granulomatous diseases
–Sarcoidosis
–Eosinophilic granulomas
–Tuberculosis
–Coccidioidomycosis
–Coccidioidomycosis
–Lymphoma
-
Immobilization
–Bone resorption exceeds bone mineral accretion
-
Malignancy
–Neoplasms (leukemia, rhabdomyosarcoma,
ovarian tumor, brain tumor)
–Bony metastases
–Synthesis of parathyroid-related protein
(PTHrP)
-
Drugs
–Thiazide diuretics
–Lithium
–Vitamin A analogs
–Calcium supplements
–Alkali
-
Hypophosphatemia
-
Hyperthyroidism
-
Adrenal insufficiency
-
Pheochromocytoma
-
Renal failure
-
Williams syndrome
-
Juvenile rheumatoid arthritis
Workup and Diagnosis
- History
–Infant/young child: Constipation, anorexia, poor weight gain and/or poor linear growth
–Older child/adolescent: Anorexia, nausea, vomiting, abdominal pain, dyspepsia, constipation; polyuria, polydipsia; weakness; impaired ability to concentrate, altered consciousness (irritability, confusion, depressive symptoms, lethargy)
–All ages: Dietary intake, medications/supplements, family history of calcium disorders or neoplasms
-
Physical exam: Usually normal
-
Labs
–Total and ionized calcium, urinary calcium excretion
–Phosphorus
–Intact PTH, PTHrP
–T4, TSH
–Complete metabolic panel
–Vitamin D levels: 25-OH-vitamin D and 1,25-(OH)2vitamin D
–Evaluation of associated endocrine tumors (for MEN)
-
Studies
–ECG: Shortened QT interval
–Abdominal ultrasound: Nephrocalcinosis, renal calculi
Treatment
-
Treatment depends on severity and etiology
-
Keep well hydrated (orally) to prevent renal damage
-
FHH: No therapy required
-
If Ca <12 mg/dL and patient is asymptomatic: May delay treatment until cause is identified
-
If Ca 10.5–12 mg/dL patient is symptomatic: Begin treatment; if Ca >12 mg/dL: Treat immediately
-
Elements of therapy
–Hydration: IV 0.9% saline (2×maintenance)
–Calciuresis: IV Lasix (1 mg/kg/dose)
–Antiresorptive agents if hydration and diuretics are ineffective
-
PTH gland adenoma/hyperplasia
–Parathyroidectomy
-
Immobilization
–Low-calcium diet, avoidance of vitamin D, hydration
-
Discontinue drugs that increase serum calcium
-
Treatment of endocrine disorders
>
Book Source Details
- Book Title: In A Page: Pediatric Signs and Symptoms
- Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
- Year of Publication: 2007
- Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Hypercalcemia
Read excerpts from these other book chapters related to Hypercalcemia:
Medical Books Excerpts
- Hypercalcemia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Hypercalcemia
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More About This Book:
Title: In A Page: Pediatric Signs and Symptoms
Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 1-4051-0427-9
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HYPERCALCEMIA (Differential Diagnosis in Primary Care)
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