What is Hypercalcemia?
Hypercalcemia is happens when a person has too much calcium in their blood. It is also important in blood clotting and bone health.
However, too much of it can cause problems. Hypercalcemia makes it hard for the body to carry out its normal functions. Extremely high levels of calcium can be life-threatening.
Complications with hypercalcemia
Hypercalcemia can cause kidney problems, such as kidney stones and kidney failure. Other complications include irregular heartbeats and osteoporosis.
Hypercalcemia can also cause confusion or dementia since calcium helps keep your nervous system functioning properly. Serious cases can lead to a potentially life-threatening coma.
Causes of hypercalcemia
Your body uses the interaction between calcium, vitamin D, and parathyroid hormone (PTH) to regulate calcium levels.
PTH helps the body control how much calcium comes into the blood stream from the intestines, kidneys, and bones. Normally, PTH increases when the calcium level in your blood falls and decreases when your calcium level rises.
Your body can also make calcitonin from the thyroid gland when your calcium level gets too high. When you have hypercalcemia, there is excess calcium in your blood stream and your body can’t regulate your calcium level normally.
There are several possible causes of this condition:
The parathyroid glands are four small glands located behind the thyroid gland in the neck. They control the production of the parathyroid hormone, which in turn regulates calcium in the blood.
Hyperparathyroidism occurs when one or more of your parathyroid glands becomes overly active and releases too much PTH. This creates a calcium imbalance that the body cannot correct on its own. This is the leading cause of hypercalcemia, especially in women over 50 years old.
Lung diseases and cancers
Granulomatous diseases, such as tuberculosis and sarcoidosis, are lung diseases that can cause your vitamin D levels to rise. This causes more calcium absorption, which increases the calcium level in your blood.
Some cancers, especially lung cancer, breast cancer, and blood cancers, can raise your risk for hypercalcemia.
Medication side effects
Some medications, particularly diuretics, can produce hypercalcemia. They do this by causing severe fluid diuresis, which is a loss of body water, and an underexcretion of calcium. This leads to an excess concentration of calcium in the blood.
Other drugs, such as lithium, cause more PTH to be released.
Dietary supplements and over-the-counter medications
Taking too much vitamin D or calcium in the form of supplements can raise your calcium level. Excessive use of calcium carbonate, found in common antacids like Tums and Rolaids, can also lead to high calcium levels.
High doses of these over-the-counter products are the third most common cause of hypercalcemia in the United States.
This usually leads to mild cases of hypercalcemia. Dehydration causes your calcium level to rise due to the low amount of fluid you have in your blood. However, the severity greatly depends on your kidney function.
In people with chronic kidney disease, the effects of dehydration are greater.
Symptoms of Hypercalcemia
You might not have any noticeable symptoms if you have mild hypercalcemia. If you have a more serious case, you will typically have signs and symptoms that affect various parts of your body.
Symptoms related to the kidneys include:
- excessive thirst
- excessive urination
- pain between your back and upper abdomen on one side due to kidney stones
High calcium can affect the electrical system of the heart, causing abnormal heart rhythms.
Calcium levels can affect your muscles, causing twitches, cramps, and weakness.
Symptoms related to the abdomen include:
- abdominal pain
- decreased appetite
High calcium levels can affect bones, leading to:
- bone pain, osteoporosis, fractures from disease
Hypercalcemia can also cause neurological symptoms, such as
- depression, memory loss, and irritability. Severe cases can cause confusion and coma.
If you have cancer and experience any symptoms of hypercalcemia, call your doctor immediately. It’s not uncommon for cancer to cause elevated calcium levels. When this occurs it’s a medical emergency.
Diagnosis of hypercalcemia
Your doctor can use blood tests to check the calcium level in your blood. Urine tests that measure calcium, protein, and other substances can also be helpful.
If your doctor finds a high calcium level, they’ll order more tests to find out the cause of your condition. Blood and urine tests can help your doctor diagnose hyperparathyroidism and other conditions.
Tests that can allow your doctor to check for evidence of cancer or other diseases that can cause hypercalcemia include:
- MRI scans, which produce detailed images of your body’s organs and other structures
- DEXA bone mineral density tests, which evaluate bone strength.
- chest X-rays, which can reveal lung cancer
- mammograms, which help diagnose breast cancer
- CT scans, which form a more detailed image of your body
Treatment of hypercalcemia
Treatment options for hypercalcemia depend on the severity of the condition and the underlying cause.
You may not need immediate treatment if you have a mild case of hypercalcemia, depending on the cause. However, you will need to monitor its progress. Finding the underlying cause is important.
The effect that elevated calcium levels have on your body relate not just to the level of calcium present, but how quickly it rises. Therefore, it’s important to stick to your doctor’s recommendations for follow-up.
Even mildly elevated levels of calcium can lead to kidney stones and kidney damage over time.
Moderate to severe cases
You will likely need hospital treatment if you have a moderate to severe case. The goal of treatment is to return your calcium level to normal. Treatment also aims to prevent damage to your bones and kidneys. Common treatment options include the following:
- Calcitonin is a hormone produced in the thyroid gland. It slows down bone loss.
- Corticosteroids are anti-inflammatory medications. They’re useful in the treatment of too much vitamin D.
- Loop diuretic medications can help your kidneys move fluid and get rid of extra calcium, especially if you have heart failure.
- Intravenous fluids hydrate you and lower calcium levels in the blood.
- Intravenous bisphosphonates lower blood calcium levels by regulating bone calcium.
- Dialysis can be performed to rid your blood of extra calcium and waste when you have damaged kidneys.
This is usually done if other treatment methods aren’t working.
Depending on your age, kidney function, and bone effects, you might need surgery to remove the abnormal parathyroid glands. This procedure cures most cases of hypercalcemia caused by hyperparathyroidism.
If surgery isn’t an option for you, your doctor may recommend a medication called cinacalcet (Sensipar). This lowers your calcium level by decreasing PTH production. If you have osteoporosis, your doctor might have you take bisphosphonates to lower your risk of fractures.
If you have cancer, your doctor will discuss treatment options with you to help you determine the best ways to treat hypercalcemia.
You might be able to get relief from symptoms through intravenous fluids and medications like bisphosphonates. This might make it easier for you to deal with your cancer treatments.
The medication cinacalcet can also be used to treat high calcium levels due to parathyroid cancer. Research suggests it may also have a role in the treatment of hypercalcemia due to other cancers as well.