HYPERCALCEMIA
HYPERCALCEMIA: Excerpt from Differential Diagnosis in Primary Care
Hypercalcemia, may result from disorders of calcium storage, intake, regulation, and transport.
HYPERCALCEMIA
Storage
Storage of calcium is in the bone. It follows that diseases that invade the bone will cause excessive release of calcium. Thus, metastatic carcinoma will cause an elevation of calcium in the blood. Paget disease by increasing the osteoclastic activity in the bone may cause an elevated calcium level.
Intake
Increased intake of calcium usually does not cause hypercalcemia but when associated with the milk–alkali syndrome or hypervitaminosis D it may.
Regulation
Excessive secretion of parathyroid hormone by the parathyroid gland or ectopic PTH secretion by a neoplasm elsewhere will cause hypercalcemia.
Transport
Half the calcium in the blood is transported by protein. It follows the conditions with increased plasma protein such as multiple myeloma and Boeck sarcoid may be associated with hypercalcemia.
Approach to the Diagnosis
A history of neoplasm or clinical evidence of bone disease should alert one to the possibility of metastatic neoplasm. Symptoms of polyuria, polydypsia, weakness, pathologic fracture, and weight loss should suggest hyperparathyroidism. Serial calcium, phosphorus, and alkaline phosphatase levels and serum PTH assay and skeletal survey should pin down the diagnosis of hyperparathyroidism and metastatic neoplasm. A bone scan will also be helpful in identifying metastasis. A cortisone suppression test will help differentiate hyperparathyroidism from metastasis. The serum calcium will not be lowered by cortisone in hyperparathyroidism.
Other Useful Tests
- CBC (myelophthisic anemia)
- Sedimentation rate (neoplasm)
- Chemistry profile (hyperparathyroidism)
- Free T4 (hyperthyroidism)
- Serum 25-hydroxy-calciferol (25-COH) vitamin D (hypervitaminosis D)
- Protein electrophoresis (sarcoidosis, multiple myeloma)
- MRI of the neck (parathyroid adenoma)
- Endocrinology consult
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Hypercalcemia (A Pocket Manual of Differential Diagnosis)
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