What is the significance of hypercalcemia in a 63-year-old female with a history of Diabetes Mellitus (DM) type 2, Hypertension (HTN), Gastroesophageal Reflux Disease (GERD), Chronic Pain, Chronic Obstructive Pulmonary Disease (COPD), and Hyperlipidemia?

From the Guidelines

Hypercalcemia in this 63-year-old female with multiple comorbidities, including Diabetes Mellitus (DM) type 2, Hypertension (HTN), Gastroesophageal Reflux Disease (GERD), Chronic Pain, Chronic Obstructive Pulmonary Disease (COPD), and Hyperlipidemia, is a significant concern that requires prompt evaluation and management to prevent potential complications, as suggested by the most recent guidelines 1.

Key Considerations

• The patient's hypercalcemia may be associated with increased mortality and cardiovascular events, as indicated by recent studies 1.
• Primary hyperparathyroidism is a common cause of hypercalcemia in outpatients and should be suspected, especially given the patient's age.
• Medication effects, such as thiazide diuretics or calcium-containing antacids, should be reviewed and potentially adjusted.
• The patient's GERD treatment and chronic pain management should be assessed, as immobility and certain medications can contribute to hypercalcemia.

Recommendations

• Repeat the calcium measurement along with albumin levels to calculate corrected calcium.
• Check parathyroid hormone (PTH), vitamin D levels, phosphorus, and renal function to determine the underlying cause of hypercalcemia.
• Avoid hypercalcemia, as recommended by the Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline update 1.
• Consider treatment with hydration, bisphosphonates, denosumab, steroids, and/or calcitonin, as recommended by the NCCN Guidelines for multiple myeloma 1.
• Refer the patient to an endocrinologist or surgeon if primary hyperparathyroidism is diagnosed, particularly if the calcium level rises further or symptoms develop such as bone pain, kidney stones, or neurological changes.

From the FDA Drug Label

Approximately 60% of patients with mild (iPTH ≥ 300 to ≤ 500 pg/mL), 41% with moderate (iPTH > 500 to 800 pg/mL), and 11% with severe (iPTH > 800 pg/mL) secondary HPT achieved a mean iPTH value of ≤ 250 pg/mL. Seventeen patients with severe hypercalcemia due to primary HPT, who had failed or had contraindications to parathyroidectomy, participated in an open-label, single-arm study. At baseline the mean (SE) serum calcium was 12.7 (0.2) mg/dL. At the end of the titration phase the mean (SE) serum calcium was 10.4 (0.3) mg/dL, which is a mean reduction of 2. 3 (0. 3) mg/dL from baseline.

The significance of hypercalcemia in a 63-year-old female with a history of Diabetes Mellitus (DM) type 2, Hypertension (HTN), Gastroesophageal Reflux Disease (GERD), Chronic Pain, Chronic Obstructive Pulmonary Disease (COPD), and Hyperlipidemia is that it may be related to primary hyperparathyroidism. The drug label provides information on the treatment of hypercalcemia due to primary hyperparathyroidism with cinacalcet, which suggests that hypercalcemia can be a significant issue in patients with this condition. However, the label does not provide direct information on the significance of hypercalcemia in the context of the patient's specific medical history. Key points to consider:

• Hypercalcemia can be a significant issue in patients with primary hyperparathyroidism.
• Cinacalcet can be used to treat hypercalcemia due to primary hyperparathyroidism.
• The patient's medical history, including DM type 2, HTN, GERD, Chronic Pain, COPD, and Hyperlipidemia, may be relevant to the management of hypercalcemia, but the label does not provide direct information on this topic 2.

From the Research

Significance of Hypercalcemia

The significance of hypercalcemia in a 63-year-old female with a history of Diabetes Mellitus (DM) type 2, Hypertension (HTN), Gastroesophageal Reflux Disease (GERD), Chronic Pain, Chronic Obstructive Pulmonary Disease (COPD), and Hyperlipidemia can be understood by considering the following points:

• Hypercalcemia is a condition characterized by elevated serum calcium levels, which can be caused by various factors, including primary hyperparathyroidism, malignancy, and other medical conditions 3, 4, 5, 6, 7.
• The patient's age and medical history are relevant, as hypercalcemia is more common in older adults and can be associated with various comorbidities, such as kidney disease, cardiovascular disease, and osteoporosis 4, 6.
• The symptoms of hypercalcemia can vary, ranging from mild to severe, and may include nausea, vomiting, dehydration, confusion, somnolence, and coma 3, 4, 6.

Causes and Diagnosis of Hypercalcemia

The causes of hypercalcemia can be divided into two main categories:

• PTH-dependent causes, such as primary hyperparathyroidism, and
• PTH-independent causes, such as malignancy 3, 4, 5, 6, 7.
• The diagnosis of hypercalcemia involves measuring serum calcium levels, parathyroid hormone (PTH) levels, and other laboratory tests to determine the underlying cause 3, 4, 5, 6, 7.

Treatment and Management of Hypercalcemia

The treatment of hypercalcemia depends on the underlying cause and severity of the condition:

• Mild hypercalcemia may not require immediate treatment, while severe hypercalcemia requires prompt medical attention 3, 4, 5, 6.
• Treatment options include hydration, loop diuretics, bisphosphonates, calcitonin, and glucocorticoids, depending on the cause and severity of hypercalcemia 3, 4, 5, 6, 7.
• In some cases, surgery may be necessary to treat underlying conditions, such as primary hyperparathyroidism 4, 6.

Prognosis and Outcome

The prognosis and outcome of hypercalcemia depend on the underlying cause and severity of the condition:

• Asymptomatic primary hyperparathyroidism has an excellent prognosis with medical or surgical management 4.
• Hypercalcemia of malignancy is associated with poor survival 4.
• The long-term prognosis depends on the underlying disease, and treatment can improve symptoms and reduce serum calcium levels 3, 4, 5, 6.