Hypercalcaemia

Question 1

Causes of hypercalcaemia

Answer 1

1. Primary HyperPTH (from solitary adenoma; rarely multiple endocrine neoplasia)
2. Malignancy
3. Decreased Vit d
4. Increased bone turnover (e.g. hyperthyroidism, thiazides, Vit A intoxication)
5. Renal failure & secondary HyperPTH
6. Familial hypocalciuric hypercalcaemia
7. Other (e.g. lithium increases PTH)

Question 2

Non specific symptoms of high calcium

Answer 2

Tiredness weakness & episodes of confusion
Anorexia & constipation
Nausea & vomiting
Acute abdominal pain (from acute pancreatitis)
Polyuria & polydipsia
Hx of HTN or bradycardia

Question 3

Specific symptoms of high calcium

Answer 3

1. Peptic ulcer or renal colic (stones, moans, bones & abdominal groans from primary HyperPTH)
2. Neck mass
3. Band keratopathy on eye examination

Question 4

Hypercalcaemia history

Answer 4

1. Past history of malignant disease
2. Drugs (thiazides, lithium, Vit D, calcium)
3. CKD ( cause of secondary HyperPTH)
4. Symptoms of thyrotoxicosis and hypercalcaemia
5. Ask about recent immobilisation
6. Family history of hypercalcaemia
   - familial hypocalciuric hypercalcaemia
   - Multiple endocrine neoplasia syndromes (ie MEN1 MEN2)

Question 5

Hypercalcaemia investigations

Answer 5

1. Total serum calcium & correct for hypoalbuminaemia
2. PTH
3. In a young otherwise asymptomatic person with marginal elevation OT PTH, a 24 hour urine calcium examination to exclude Familial Hypocalciuric Hypercalcaemia (FHH
4. IF low or undetectable PTH, consider
   - malignancy: measure PTH-related protein, perform bone scan & protein electrophoretogram
   - granulomatous disease (sarcoidosis, TB, berylliosis, lymphoma): look for increased Vit D
5. CXR for ?malignancy