Hypercalcemia

Symptoms Of Hypercalcemia

The severity of the symptoms of hypercalcemia does not depend on how high the calcium levels are. They vary from person to person, and older people generally have more symptoms than younger people.

These symptoms develop slowly, irrespective of the cause. Some of the mild to moderate symptoms may include:

• Loss of appetite

• Nausea and vomiting

• Constipation

• Abdominal pain

• Polydipsia (excessive thirst)

• Polyuria (frequent urination)

• Peptic ulcers

• Pancreatitis

• Osteoporosis

• Osteomalacia

• Arthritis 

• Pathological fractures

• Fatigue/tiredness

• Weakness

• Muscle pain

• Confusion and disorientation

• Headaches

• Difficulty to concentrate

• Depression

Serious symptoms can include:

• Seizure

• Irregular heartbeat

• Heart attack

• Loss of consciousness

• Coma

Causes Of Hypercalcemia

Calcium is very important in building strong bones and teeth, muscles contraction and nerve signal transmission. Parathyroid glands secrete a hormone when there are decreased levels of calcium in the blood, which triggers:

1. Bones to release calcium into the bloodstream

2. The digestive tract to absorb more and more calcium

3. Kidneys to excrete less calcium and activate Vitamin D (which plays a vital role in the absorption of calcium).

Common conditions associated with hypercalcemia can be divided into two major categories- parathyroid hormone (PTH) causes and non-parathyroid hormone causes. They are as follows:

Parathyroid hormone causes of hypercalcemia

• Hyperparathyroidism: It is a condition caused due to an overactive parathyroid gland and is the most common cause of hypercalcemia. It can be a result of a noncancerous (benign) tumor or enlargement of one or more of the four parathyroid glands.

• Hereditary factors: A rare genetic disorder known as familial hypocalciuric hypercalcemia causes an increase of calcium in the blood because of defects in calcium receptors in the body. 

• Endocrine causes: Theses include diseases such as thyrotoxicosis (stimulation of cells osteoclasts by thyroid hormone), hypoadrenalism (decreased functioning of the adrenal glands located just above the kidneys, also known as Addison’s disease) and pheochromocytomas (hormone-secreting tumor that can occur in the adrenal glands).

• Medications: Certain drugs such as thiazide diuretics (used to treat high blood pressure) and lithium (used to treat bipolar disorder) can increase the release of the parathyroid hormone leading to hypercalcemia.

• Cancer: Lung cancer, breast cancer, kidney cancer, some blood cancers like multiple myeloma, and the spread of cancer (metastasis) to the bones can increase the risk of hypercalcemia. 

Non-parathyroid hormone causes of hypercalcemia

• Supplements: Excessive intake of calcium or Vitamin D supplements over a period of time can raise calcium levels in the blood above the normal range.

• Immobility: Hypercalcemia can develop in people who have a condition that causes them to spend a lot of time sitting or lying down. This is due to the release of calcium into the blood from the bones that don’t bear weight.

• Severe dehydration: Less fluid in blood can cause a rise in calcium concentrations leading to mild or transient hypercalcemia. However, the severity of hypercalcemia depends on the kidney function. In people with long term kidney disorders, the effect of dehydration is greater.

• Other diseases: Tuberculosis and sarcoidosis, are lung diseases that can elevate levels of Vitamin D in the blood, which stimulates the digestive tract to absorb more calcium. Paget's disease has also been linked to an increase in levels of calcium.

The normal functioning of the body depends on the hormones to be released in the right quantity. If the parathyroid glands make too much or too little hormone, it disrupts this balance. Read more about hyperparathyroidism.
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Risk Factors For Hypercalcemia

• Women in the postmenopausal age.
• Older individuals in their 50s or 60s.
• Family history of hyperparathyroidism.
• Past history of familial syndromes such as multiple endocrine neoplasia (diseases affecting the hormone-producing, endocrine system) type 1, type 2A or type 4, familial hypocalciuric hypercalcemia (an inherited disorder that causes abnormally high levels of calcium in the blood and low to moderate levels of calcium in the urine), hyperparathyroid-jaw tumor syndrome (a condition characterized by overactivity of the parathyroid glands).

Less common risk factors of hypercalcemia include:

• Any past or current history of lithium use.

• Radiation exposure to head and neck region.

Note: Hypercalcemia generally presents with mild or no symptoms in many cases and may go unnoticed. With timely preventive health check-ups, one can spot and address risk factors for certain diseases that might crop up with old age. Learn more about the need for preventive health checkups for the elderly.
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Diagnosis Of Hypercalcemia

Hypercalcemia can cause a very few signs or symptoms, and the individuals may not know that they have the disorder until routine blood tests like serum calcium can help determine if the individual has hypercalcemia. 

Blood tests can also show whether your parathyroid hormone level is high, indicating that you have hyperparathyroidism. If hyperparathyroidism has been excluded, then further tests will be required to determine whether the cause of hypercalcemia is associated with malignancy. In these cases, parathyroid hormone (PTH) levels will be undetectable and further tests are conducted. They include:

• Erythrocyte sedimentation rate (ESR): This test indicates the presence of inflammation in the body but does not locate the cause.

• Immunoglobulin panel: This test measures the levels of certain immunoglobulins or antibodies in the blood. 

• Protein electrophoresis: This test is done to identify some unique kind of protein in the body that is present in certain kinds of cancer. 

• Bence Jones proteins: This test measures the levels of the Bence Jones protein in the urine which is specifically produced by plasma cells that provide immunity to the body. 

• Chest X-ray: An imaging test that uses X-rays to look at the structures and organs in the chest and detect certain lung and heart problems.

• Liver function tests (LFTs): Group of blood tests commonly performed to evaluate the function of the liver.

• Abdominal ultrasound: This test is used to create images of organs in the abdomen including liver, gallbladder, spleen, pancreas, and kidneys. 

• Imaging of bones: It is a specialized radiology procedure used to examine the various bones of the skeleton

Genetic testing is gaining importance lately and is becoming a routine part of the investigation of a case of hypercalcemia where a family history is appropriate. 

Prevention Of Hypercalcemia

Not all hypercalcemia can be prevented, but avoiding excess intake of calcium pills and calcium-based antacid tablets are recommended. Talk to the doctor if there is any family history of high calcium, kidney stones, or parathyroid conditions. Avoid taking dietary supplements, vitamins, or minerals without first discussing them with the doctor.

Also, changes in the calcium level in the blood can be linked to cancer. So the best way to control calcium is to treat cancer itself.

Specialist To Visit

The primary cause of hypercalcemia is abnormal functioning of the parathyroid glands or any kind of malignancies. Hypercalcemia can also weaken the bones, create kidney stones and interfere with the functioning of the heart and brain. The doctors to visit are:

• Endocrinologist

• Nephrologist

• Oncologist

An endocrinologist treats metabolic and hormone disorders. A nephrologist focuses on kidney diseases whereas an oncologist specializes in treatment of cancer.

If you are noticing any of the symptoms, seek advice from our world-class medical professionals. 
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Treatment Of Hypercalcemia

In the case of mild to moderate hypercalcemia, monitoring the bones and kidneys over time to be sure they are healthy is the best option. In severe cases of hypercalcemia medications or treatment of the underlying disease, including surgery might be required.

A. Medications

The most recommended medications include:

1. Drugs acting on osteoclasts

• Calcitonin: The hormone controls the levels of calcium in the blood. It is a calcitonin receptor agonist that acts by suppressing the activity of osteoclasts (bone destroying cells).

• Mithramycin: This drug can block the function of osteoclasts and is often administered to patients with malignancy-associated hypercalcemia (MAH). This drug can cause severe toxicity in kidneys, liver, and bone marrow.

2. Drugs used in cancer related hypercalcemia

• Bisphosphonates: It can lower calcium levels and is used to treat hypercalcemia due to cancer. 

• Denosumab: This drug is used in the treatment of cancer-caused hypercalcemia in patients who don't respond well to bisphosphonates.

• Pamidronate: This can be given intravenously in patients with malignancies. This agent often will normalize the serum calcium level. This treatment has a rapid onset but short duration of effect and patients can develop tolerance to the calcium-lowering effect.

• Prednisone: Short-term use of steroid pills such as prednisone is usually helpful in hypercalcemia caused by high levels of Vitamin D, myeloma, and lymphoma.

3. Other drugs

• Cinacalcet: This drug has been approved for managing hypercalcemia and acts by controlling overactive parathyroid glands.

• IV fluids and diuretics: These might be required in case of emergency to lower the calcium level so as to prevent heart rhythm problems or damage to the nervous system.

• Ketoconazole: This is an antifungal drug, used in hypervitaminosis D (excessive Vitamin D in the body) to prevent toxicity and overproduction of calcium.

B. Dialysis

In severe cases of resistant, life-threatening hypercalcemia, hemodialysis (a treatment to filter wastes and water from blood) is effective in lowering serum calcium levels.

C. Surgery

• In hyperparathyroidism leading to hypercalcemia, urgent parathyroidectomy (removal of affected parathyroid gland) is potentially curative. In most cases, only one of the four parathyroid glands is affected. 

• A special test is used to scan and pinpoint the gland or glands that aren't working properly. This procedure uses an injection of a small dose of radioactive material into the glands.

Home-care For Hypercalcemia

Mild hypercalcemia may not require any treatment. However, if the condition is more serious or severe, the doctor may prescribe medications to lower the levels of calcium along with treating the underlying cause.

Certain lifestyle modifications can help keep calcium levels balanced and bones healthy. They are:

1. Stay hydrated

• Drinking water can lower blood calcium levels and prevent kidney stones.

• Make sure to keep a bottle of water nearby at night.

2. Quit smoking

• Smoking can increase the risk of bone loss and cancer. 

• In addition to improving general health, quitting smoking will reduce the risk of cancer and other health problems.

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3. Exercise regularly

• Staying active is the key to promoting good health.

• Resistance training can help improve bone strength and health.

4. Follow proper medical advice

• To decrease the risk of consuming too much Vitamin D or calcium supplements and developing hypercalcemia.

• Use antacids that have magnesium and avoid antacids that have a lot of calcium in them. 

• Talk to the doctor about what medicines and herbs are safe in case of hypercalcemia.

5. Have a balanced diet

• Decrease the number of dairy foods like cheese, milk, yogurt, and ice cream.

• Avoid food items like okra, spinach, soya, and bread that have high levels of calcium in them.

• Read the labels of food carefully and skip items that have high calcium. substances to ensure the quantity.

Every person is different and so are the nutritional requirements. There are some dietary guidelines that one should follow for a proper balanced diet. Understand how to reap benefits from your diet.
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If the doctor has prescribed medications to keep the calcium levels in control, take them the right way and the right quantity. Call the doctor if there are any side effects.

Complications Of Hypercalcemia

Hypercalcemia complications can range from manageable to being fatal. They include:

• Osteoporosis: It is also known as bone-thinning disease as the bones continue to release calcium into the blood. This may lead to bone fractures, spinal column curvature, and loss of height.

• Kidney stones: This may be due to the formation of crystals in the kidneys due to excessive calcium in the blood. These crystals can combine over time to form kidney stones. Passing a stone during urination can be extremely painful.

• Kidney failure: This complication occurs in severe hypercalcemia and it can damage the kidneys, limiting their ability to cleanse the blood and eliminate fluid.

• Arrhythmia: Hypercalcemia can lead to irregular heartbeat as increased calcium levels may affect the electrical impulses that regulate the heartbeat.

• Nervous system problems: Hypercalcemia can lead to confusion, dementia, and coma, in severe cases.

Some of the other complications of hypercalcemia include:

• Depression

• Bone pain

• Constipation

• Pancreatitis

• Gastric ulcers

• Paresthesias

• Syncope 

Alternative Therapies For Hypercalcemia

Mild to moderate symptoms of hypercalcemia can be managed by certain lifestyle modifications and prescribed medications. However, there is a lot of research going on to reduce calcium levels through alternate medicine as well. Some of it includes:

1. Herbal therapy

Herbs are sometimes used to counter the bone loss that can occur from hyperparathyroidism, though scientific studies around it are lacking. They are generally available as standardized dried extracts like pills, capsules, tablets, teas, or tinctures/liquid extracts like alcohol extraction 

Talk to the doctor before taking any herbs, in case of hypercalcemia due to hyperparathyroidism. The herbs that have shown positive results in lowering the calcium levels are:

• Chaste tree (Vitex agnus castus) 

• Dandelion (Taraxacum officinale) 

• Fructus ligustri lucidi (FLL) 

2. Physical therapy

A sedentary lifestyle can cause the longer bones to absorb its calcium leading to hypercalcemia. Being active and physical therapy have proven to be effective in these cases. The common uses of this therapy include:

• Weight bearing help prevent osteoporosis and immobility

• Prevention of fractures 

• Increased strength and range of motion (ROM)

Living With Hypercalcemia

The severity of hypercalcemia depends on the cause. When hypercalcemia is due to hyperparathyroidism, symptoms tend to be mild but are prolonged. However, hypercalcemia due to malignancy can have severe symptoms and poor quality of life due to aggressive treatment modalities. 

The mild symptoms of hypercalcemia can be managed by following certain simple lifestyle changes like:

• Stop taking calcium supplements

• Avoid medications containing calcium carbonate, which are generally used to treat acid reflux

• Stay active to keep the digestive system moving

• Avoid long periods of inactivity and a sedentary lifestyle

• Drink a lot of liquids and stay hydrated as hydration aids the body in breaking down food

• Abstain from consuming large quantities of calcium-rich foods

• Do not deprive the body of calcium-rich foods completely as they are required for other functional nutrients

• Talk to your doctor before making any drastic changes and come up with a plan that best suits your needs

• Quit smoking