Renal System >
Hypercalcaemia

Calcium blood serum levels higher than 2.6 mmol/L

Risk Factors
  • Genetic predisposition
Aetiology
  • Common causes:
    • Primary hyperparathyroidism (parathyroid adenoma)
    • Malignancy
  • Other causes:
    • Tertiary hyperparathyroidism
    • Sarcoidosis
    • Thyrotoxicosis
    • Drugs e.g. thiazides, lithium
    • Excessive ingestion of calcium carbonate
    • Vitamin D toxicity
    • Vitamin A intoxication
    • Immobilisation
    • Addison’s disease
    • Familial hypocalciuric hypercalcaemia (FHH
Pathophysiology
  • Primary hyperparathyroidism (PHPT):
    1. Parathyroid hormone increases osteoclast activity in bone
    2. Calcium absorption from gut and kidneys increased
    3. Vitamin D activity increased
Clinical Presentation
  • Asymptomatic:
    •  raised serum calcium concentration on biochemical testing (most common)
  • Symptomatic:
    •  “moans, bones, stones and groans”
      • depressed mood
      • musculoskeletal pain
      • renal colic
      • abdominal pain (i.e. constipation, ulcers)
    • polyuria
    • polydipsia
  • Severe:
    • nausea
    • vomiting
    • short QT – ventricular fibrillation
    • confusion
    • coma
  • Rare:
    • band keratopathy
Investigations
  • Calcium concentration
  • PTH concentration
  • 25 OH Vitamin D level
  • USS of the parathyroid gland
Management
  • Emergency:
    • Hydration with saline
  • PHPT:
    • Parathyroidectomy (affected part)
    • Conservative management
Complications
  • Cardiovascular disease
  • Low quality of life
  • Impaired cognition

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