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Elevated Calcium

What is Hypercalcemia?

Hypercalcemia is an elevated calcium (Ca2+) level in the blood, with normal levels ranging from 8.5 to 10.0 mg/dL. It can result from excessive skeletal calcium release, increased intestinal calcium absorption, or decreased renal calcium excretion. Often, it is an asymptomatic laboratory finding, but it may indicate other diseases, warranting further investigation if it persists.

Symptoms, when present, can include:

  • Kidney or biliary stones
  • Bone pain
  • Abdominal pain, nausea, vomiting
  • Increased urination
  • Depression, anxiety, cognitive dysfunction, insomnia
  • Severe cases: coma and cardiac arrest, EKG changes mimicking myocardial infarction, peptic ulcers

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Causes of Hypercalcemia

1. Abnormal Parathyroid Gland Function

  • Primary hyperparathyroidism
  • Lithium use
  • Familial hypocalciuric hypercalcemia (FHH)/familial benign hypercalcemia

2. Malignancy

  • Solid tumors with metastasis (e.g., breast cancer or squamous cell carcinoma)
  • Solid tumors with humoral mediation (e.g., lung cancer, kidney cancer, pheochromocytoma)
  • Hematologic malignancy (multiple myeloma, lymphoma, leukemia)

3. Vitamin-D Metabolic Disorders

  • Hypervitaminosis D (vitamin D intoxication)
  • Elevated 1,25(OH)2D levels (e.g., sarcoidosis and other granulomatous diseases)

4. Disorders Related to High Bone-Turnover Rates

  • Hyperthyroidism
  • Prolonged immobilization
  • Thiazide diuretic use
  • Vitamin A intoxication

5. Renal Failure

  • Severe secondary hyperparathyroidism
  • Aluminium intoxication
  • Milk-alkali syndrome
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Treatment of Hypercalcemia

1. Addressing the Underlying Cause The key to treatment is addressing the underlying cause of hypercalcemia.

2. Initial Therapy: Fluids and Diuretics

  • Hydration: Needed due to dehydration from vomiting or renal defects.
  • Increased Salt Intake: Increases body fluid volume and urinary calcium excretion.
  • Diuretics (e.g., furosemide): After rehydration, diuretics help continue large volume intravenous salt and water replacement, minimizing the risk of blood volume overload and pulmonary edema, and they also reduce renal calcium reabsorption.

3. Additional Therapy: Bisphosphonates and Calcitonin

  • Bisphosphonates: Treat osteoporosis by inhibiting osteoclastic bone resorption. Essential for patients with cancer-associated hypercalcemia.
  • Calcitonin: Blocks bone resorption and increases urinary calcium excretion, used in life-threatening hypercalcemia.

4. Other Therapies (Rarely Used)

  • Plicamycin: Inhibits bone resorption.
  • Gallium Nitrate: Inhibits bone resorption and changes bone crystal structure.
  • Dialysis: For severe hypercalcemia with renal failure, with careful monitoring of phosphate.
  • Glucocorticoids: Increase urinary calcium excretion and decrease intestinal absorption, effective in hypercalcemia due to osteolytic malignancies and hypervitaminosis D and sarcoidosis.

By targeting the root cause and using a combination of hydration, diuretics, bisphosphonates, and calcitonin, hypercalcemia can be effectively managed, especially in severe cases.

Meet Our Endocrinologists

Our Endocrinologists, Dr. Carlo A. Fumero, Sean Amirzadeh, DO, Alberto Garcia Mendez, Lauren Sosdorf, and Pedro Troya, are board certified by the American Board of Internal Medicine and have a wealth of experience treating thyroid conditions. They will work with you to create a personalized treatment plan that meets your unique needs.


What our patients say about us

Deborah Diaz
Deborah Diaz
Attentive, thorough, compassionate, genuine, loyal.
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As a patient of Dr. Troya’s for several years, I would highly recommend this endocrinologist to anyone. He gives full attention to you and your needs without being pressed for time. His diagnosis and treatments are thorough with up-to-date technology and years of experience. His concern and compassion are genuine with your best interest at heart. After having multiple biopsies performed by Dr. Troya, I am definitely a loyal follower.
Victor Cruz
Victor Cruz
Successful diabetes treatment, complete care
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I have been going to Dr. Troya for a year. He has treated my Diabetes with great success. He communicates with my other doctors, so he has a complete medical history of all my health issues. We need more caring doctors like Dr. Troya who has the patient’s best interest at heart. I am very thankful for Dr. Pedro Troya.
Michael Hoover
Michael Hoover
Stabilized diabetes, regained pilot's license.
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I was a private pilot for 34 years before contracting Type 1 diabetes after a severe case of food poisoning in March of 2008. My first endocrinologist refused to assist me in working with the FAA to retain my pilot’s license. I became a patient of Dr. Troya in 2010. Since that time, he has put me on a Continuous Glucose Monitoring regime and helped me stabilize my blood glucose levels to levels that allow me to pass my FAA medical exam. His caring and interest in each patient's personal issues, as well as their medical outcomes, marks him as an outstanding physician.
KC Mullis
KC Mullis
Personable, caring, thorough, trusted physician.
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Dr. Carlos Fumero is a very personable and caring physician. He takes the time to listen and is very thorough in his evaluations and explanations. He exercises incredible care and concern. I have been referring family members and friends to Dr. Carlos Fumero for almost two years now. We are all exceptionally grateful to have found such a trusted physician. Thank you, Dr. Carlos Fumero. Your kindness and medical expertise are more appreciated than I could ever express in words.
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