Hi I'm Dr Wengie I'm a board-certified endocrinologist in Sacramento California today I'm going to discuss a topic that is very common in our practice called hypercalcemia or high calcium could be caused because of various reasons one of the very common reason is hyperparaphytism that is one of the hormonal causes for high calcium but there are some known hormonal causes as well and we'll talk about those in a second let's discuss what is high calcium and why does it matter if it's high or low and what should make it go high or low hypercalcemia happens when there's a dysregulation in the calcium usually calcium is in a very fine balance.
It's usually maintained not high or low in a very narrow range certain things can excite it and make it go higher in our system calcium is a mineral that is usually present in our bones majority of it more than 90 percent and in the bones, it adds on to building up new bones and adds to the strength of the bones what else is calcium present it's present in our muscle tissue and in our cells in the muscle tissue it helps contract the muscle including the heart muscle in the cells it helps other functions of the body, for example, it helps for the nerves and nervous system and brain to work properly it also helps to keep the regulation of the heart rhythm.
That's why if your calcium goes high or low that can add on to the risk of arrhythmias it also helps maintain the blood pressure so those are the most important things that we are usually concerned about but in the excess amount it can also concentrate in the kidneys can cause kidney stones if it's too much in the blood it can also cause us to be confused not able to concentrate depression anxiety and few other reasons to feel unwell fatigue is another big reason so most of the people who come to us are asymptomatic and they do not have any symptoms until they get the treatment of the condition and then they realize how much better they feel.
It was probably high calcium that was adding on to some of the subtle symptoms that they never added on to their health which could be again fatigue poor well-being um anxiety depression or generally pulling feeling poor in general all right so what else can cause high calcium can be caused by hyper parapyratism which is a hormone in the lower neck and we have poor four parathyroid glands most of us some people have an excessive or accessory gland which is the fifth one but most people have four sometimes one of them harbours a tumour which is usually not cancer and that tumour can make too much parathyroid hormone which goes to the periphery or in our system and makes our body absorb more calcium from our gut.
More calcium gets absorbed from the bones making the bones weaker and makes us that high risk for fractures when it absorbs more from the gut again the blood levels can go up to a certain extent and once the blood calcium goes up too much then we start peeing out the calcium in the urine and that can concentrate and cause kidney stones now once we understand this we can identify when somebody has high calcium what could be the cause majority of the patients have hyperparathyroidism or the parathyroid problem that we just talked about the other common cause for high calcium is malignancy or cancer and if that's the case usually the presentation tells us a lot about it and we can determine if a lot of people come with the diagnosis of cancer and that's when we discover high calcium.
In some cases that diagnosis of cancer is not known and it's during the workup of high calcium that we find out that somebody has underlying cancer or malignancy that is contributing to high calcium other than that there could be various other factors like certain medications for blood pressure called hydrochlorothiazide which makes us absorb more calcium from the kidneys and makes the blood calcium go up there's also certain other medications called um lithium or Teflon for asthma or um teriparatide which is a hormone that we give for management of osteoporosis those are certain medications that we have to watch out for that may make blood calcium go high there are other conditions that are not related to parathyroid not related to the malignancy that can cause high calcium as well and the most common being hyperthyroidism too much of thyroid in our system can cause high calcium as well.
Because it makes it works on osteoclasts those are the cells in our bone that resolve the bone and high activity on resorption causes high calcium in the blood pages disease too much of growth hormone those are few other conditions that can give us high calcium as well certain excessive vitamins can give us high calcium as well and most common being hypervitaminosis d so most of the time we come across low vitamin d but some people have high vitamin d and if you have too much vitamin d that can contribute to high calcium as well too mutual vitamin a can also cause high calcium so that is what we try to judge when the patient comes in where does it stand how high is the calcium what tests we need to do and based on the tests we come up with the plan what to do what kind of tests do we do at this point we usually like to do a blood test which includes a parathyroid hormone level magnesium.
Phosphorus simple blood test that gives us all the answers now we also ask patients to check 24 urine calcium excretion which is a little big deal because if the lab loses that sample then it's very frustrating for the patient to do it again so if we give you that test then make sure you tell the lab to label it and test it for you and not lose your sample because you have to collect 24-hour duration urine sample to see how much calcium you're peeing out the other test that we like to do is a bone density test that tells us how weak are your bones and if the bones are weak over time and your risk of fractures is high then that tells us how urgent it is to treat the hypercalcemia so those are some of the tests that help us risk stratify you to figure out where do you stand on treatment plan because if it's a parathyroid adenoma most of the time the treatment is surgery.
Sometimes the surgery is not indicated and we can watch you for some time and may give you conservative management and that usually includes good hydration avoid dehydration and if you're on a water pill called hydrochlorothiazide we usually stop that um and if you're on a certain amount of calcium and vitamin d supplements we may take a look into that and let you know whether we're going to stop that or continue or depending on the amount and then. In this case, take some best vitamin D supplements that are available to buy in the UK.
if the calcium is still high then we may consider either surgery or certain medications that can help the calcium in balance so hope this was helpful for you to understand if you have high calcium why do we need to treat it and what the journey is going to be like and what tests we do look forward to helping you if you come to our practice otherwise good luck to you please check with your doctor don't take this as personal advice to you you must check with your doctor to see what tests you need good luck.
