Hypercalcemia

Any factors that increase the likelihood of developing hyperparathyroidism or thyroid gland dysfunction also raise the risk of hypercalcemia.

Common risk factors include:

• Women post-menopause.
• Older adults, particularly those in their 50s and 60s.
• A family history of hyperparathyroidism.
• Previous occurrence of familial syndromes like multiple endocrine neoplasia types 1, 2A, or 4, familial hypocalciuric hypercalcemia (a genetic disorder causing elevated calcium levels), and hyperparathyroid-jaw tumor syndrome (a condition marked by parathyroid gland overactivity).

Less frequent risk factors:

• A history of lithium usage.
• Radiation exposure to the head or neck.

Note: Many individuals with hypercalcemia may not display noticeable symptoms. Regular health check-ups can help detect and manage potential risk factors, especially in older adults.

Hypercalcemia may not present obvious symptoms, and it often goes undetected until routine blood tests, such as serum calcium levels, indicate elevated calcium. Blood tests can also reveal whether parathyroid hormone (PTH) levels are high, which suggests hyperparathyroidism. If hyperparathyroidism is ruled out, further testing is necessary to determine if malignancy is involved. In these cases, PTH levels will be low or absent, prompting additional tests like:

• Erythrocyte Sedimentation Rate (ESR): This test detects body inflammation but doesn't specify the cause.
• Immunoglobulin Panel: Measures antibodies in the blood.
• Protein Electrophoresis: Identifies certain proteins indicative of some cancers.
• Bence Jones Proteins: Tests for proteins produced by plasma cells, linked to specific cancers.
• Chest X-ray: Helps identify lung or heart issues.
• Liver Function Tests (LFTs): Used to assess liver health.
• Abdominal Ultrasound: Visualizes organs in the abdomen, including the liver, kidneys, and pancreas.
• Bone Imaging: Radiology used to assess bone health.

Genetic testing is becoming more common, especially when there’s a family history of hypercalcemia.

Although hypercalcemia can't always be prevented, avoiding excessive calcium and calcium-based antacid supplements is advisable. Individuals with a family history of high calcium, kidney stones, or parathyroid issues should consult with their doctor before using calcium supplements or other vitamins and minerals.

As calcium changes can be related to cancer, managing the underlying cancer is crucial for controlling calcium levels.

Specialists to Consult

Hypercalcemia often results from parathyroid gland issues or cancer. It can weaken bones, lead to kidney stones, and disrupt heart and brain function. The following specialists can help:

• Endocrinologist: Treats hormone and metabolic disorders.
• Nephrologist: Specializes in kidney diseases.
• Oncologist: Focuses on cancer treatment.

For mild to moderate hypercalcemia, monitoring bone and kidney health over time is the preferred approach. However, in severe cases, treatment to address the underlying cause, including medications or surgery, may be necessary.

A. Medications

Key medications for hypercalcemia include:

Osteoclast Targeting Drugs

• Calcitonin: A hormone that regulates blood calcium levels by inhibiting osteoclast activity.
• Mithramycin: Blocks osteoclast function, used in cancer-related hypercalcemia, but can cause kidney, liver, and bone marrow toxicity.

Cancer-Related Hypercalcemia Medications

• Bisphosphonates: Help reduce calcium levels in cancer-related hypercalcemia.
• Denosumab: Used for patients unresponsive to bisphosphonates.
• Pamidronate: Administered intravenously, often normalizing calcium levels, but effects may be short-lived.
• Prednisone: Steroid use can help reduce calcium in certain cancers like lymphoma and myeloma.

Other Drugs

• Cinacalcet: Controls parathyroid hormone production in hypercalcemia.
• IV Fluids and Diuretics: Used in emergencies to reduce calcium and prevent heart or nerve complications.
• Ketoconazole: An antifungal that helps manage excessive Vitamin D and calcium production.

B. Dialysis

For severe, resistant hypercalcemia, hemodialysis is effective in lowering calcium levels.

C. Surgery

For hyperparathyroidism, a parathyroidectomy (removal of affected parathyroid glands) can cure hypercalcemia. In most cases, only one of the four parathyroid glands is affected. Specialized tests are used to identify the problematic glands, involving the injection of a small radioactive dose for scanning.

The complications of hypercalcemia can vary from manageable to potentially life-threatening. These include:

• Osteoporosis: Also known as bone thinning, it occurs when the bones continuously release calcium into the bloodstream, leading to bone fractures, a curved spine, and loss of height.
• Kidney Stones: Excessive calcium in the blood can form crystals that accumulate in the kidneys, eventually developing into painful stones.
• Kidney Failure: Severe hypercalcemia can damage the kidneys, impairing their ability to filter waste and fluids from the blood.
• Arrhythmia: Elevated calcium levels can disrupt the electrical signals in the heart, causing an irregular heartbeat.
• Nervous System Issues: In extreme cases, hypercalcemia may lead to confusion, dementia, or even coma.

Other possible complications include:

• Depression
• Bone pain
• Constipation
• Pancreatitis
• Gastric ulcers
• Paresthesia
• Syncope

While mild to moderate hypercalcemia can be managed with lifestyle changes and prescribed medications, research is ongoing into alternative treatments for lowering calcium levels. Some options include:

Herbal Therapy

Herbal remedies may help counter bone loss linked to hyperparathyroidism, though scientific evidence is limited. Herbs like chaste tree (Vitex agnus castus), dandelion (Taraxacum officinale), and Fructus ligustri lucidi (FLL) have shown some potential in lowering calcium levels. Always consult with your doctor before using herbal remedies, especially for hypercalcemia caused by hyperparathyroidism.

Physical Therapy

A sedentary lifestyle can lead to calcium absorption from bones, contributing to hypercalcemia. Physical activity and therapy are effective in managing this condition. Common benefits of physical therapy include:

• Weight-bearing exercises to prevent osteoporosis and immobility
• Reduced risk of fractures
• Increased strength and range of motion (ROM)

In cases of mild hypercalcemia, treatment may not be necessary. However, for more severe forms, doctors may prescribe medications to lower calcium levels and address the underlying cause.

Several lifestyle changes can help maintain balanced calcium levels and promote healthy bones. These include:

Stay Hydrated

Drinking water helps reduce blood calcium levels and prevents kidney stone formation. Keep a water bottle nearby, especially at night.

Quit Smoking

Smoking increases the risk of bone loss and cancer. Quitting will not only improve overall health but also reduce the chances of cancer and other related conditions.

Exercise Regularly

Physical activity is essential for maintaining good health. Resistance training, in particular, strengthens bones and promotes bone health.

Follow Medical Advice

To avoid excessive intake of Vitamin D or calcium supplements, which could contribute to hypercalcemia, it's important to follow your doctor's recommendations. Opt for antacids containing magnesium, and avoid those with high calcium content. Always consult your doctor about safe medications and herbs if you have hypercalcemia.

Maintain a Balanced Diet

Reduce the intake of dairy products such as cheese, milk, yogurt, and ice cream. Avoid foods like okra, spinach, soy, and bread, which are high in calcium. Always read food labels to ensure you're not consuming excessive calcium.

If prescribed medications to control calcium levels, make sure to take them as directed. Contact your doctor if you experience any side effects.

The severity of hypercalcemia depends on its cause. Hypercalcemia caused by hyperparathyroidism tends to have mild and prolonged symptoms, while hypercalcemia due to cancer can lead to severe symptoms and a reduced quality of life due to aggressive treatment approaches.

For mild hypercalcemia, lifestyle changes can help manage the condition, including:

• Stopping calcium supplements
• Avoiding calcium carbonate-based medications, commonly used for acid reflux
• Staying active to promote healthy digestion
• Avoiding prolonged periods of inactivity
• Drinking plenty of fluids to support digestion
• Limiting calcium-rich foods, but not eliminating them entirely, as they provide essential nutrients
• Discussing major changes with your doctor to find the best management plan
• Quitting smoking