What are the symptoms of hypercalcemia?

From the Guidelines

Hypercalcemia typically presents with symptoms such as polyuria, gastrointestinal disturbances, progressive dehydration, and decreases in glomerular filtration rate, which can be effectively managed with hydration, bisphosphonates, denosumab, steroids, and/or calcitonin 1. These symptoms occur due to excess bone resorption from bone disease, leading to an excessive release of calcium into the blood.

• Common symptoms of hypercalcemia include:
  • Polyuria
  • Gastrointestinal disturbances
  • Progressive dehydration
  • Decreases in glomerular filtration rate According to the NCCN MM Panel, among the bisphosphonates, zoledronic acid is preferred for the treatment of hypercalcemia 1. The severity of symptoms typically correlates with both the calcium level and how quickly it rises, making prompt medical attention necessary when hypercalcemia is suspected.
• Treatment options for hypercalcemia include:
  • Hydration
  • Bisphosphonates (such as zoledronic acid)
  • Denosumab
  • Steroids
  • Calcitonin It is essential to address the underlying cause of hypercalcemia to resolve symptoms and prevent complications like kidney damage or cardiac arrhythmias 1.

From the Research

Symptoms of Hypercalcemia

• Hypercalcemia can be asymptomatic, but it may also cause various symptoms, including:
  • Fatigue
  • Constipation
  • Nausea
  • Vomiting
  • Dehydration
  • Confusion
  • Somnolence
  • Coma 2
• The severity of symptoms depends on the level of calcium in the blood, with severe hypercalcemia (total calcium of 14 mg/dL or greater) causing more severe symptoms 2

Causes of Hypercalcemia

• Primary hyperparathyroidism (PHPT) and malignancy are the most common causes of hypercalcemia, accounting for approximately 90% of cases 2
• Other causes of hypercalcemia include:
  • Granulomatous disease (e.g., sarcoidosis)
  • Endocrinopathies (e.g., thyroid disease)
  • Immobilization
  • Genetic disorders
  • Medications (e.g., thiazide diuretics, calcium, vitamin D, or vitamin A supplements) 2

Treatment of Hypercalcemia

• Mild hypercalcemia usually does not require acute intervention, but severe hypercalcemia requires immediate treatment 2
• Treatment options include:
  • Hydration
  • Intravenous bisphosphonates (e.g., zoledronic acid, pamidronate) 2, 3, 4, 5, 6
  • Glucocorticoids (for hypercalcemia due to excessive intestinal calcium absorption) 2
  • Denosumab and dialysis (for patients with kidney failure) 2
• The choice of treatment depends on the underlying cause of hypercalcemia and the severity of symptoms 2, 3, 4, 5, 6