From the Guidelines
High calcium levels in the blood, known as hypercalcemia, are most commonly caused by hyperparathyroidism, where overactive parathyroid glands produce too much parathyroid hormone, as well as by cancer, particularly bone metastases, lung cancer, and multiple myeloma, which can release calcium from affected bones 1.
Causes of Hypercalcemia
The causes of hypercalcemia can be multifactorial and include:
- Hyperparathyroidism, which is characterized by the overproduction of parathyroid hormone, leading to an increase in calcium levels in the blood 1
- Cancer, including bone metastases, lung cancer, and multiple myeloma, which can release calcium from affected bones into the bloodstream 1
- Certain medications, such as thiazide diuretics, lithium, and excessive vitamin D supplements, which can contribute to elevated calcium levels 1
- Endocrine disorders, such as hyperthyroidism, which can also lead to hypercalcemia 1
- Granulomatous diseases, like sarcoidosis and tuberculosis, which can cause an increase in calcium levels 1
- Prolonged immobilization, which can lead to an increase in calcium release from bones into the bloodstream 1
- Kidney failure, which can reduce calcium excretion and contribute to hypercalcemia 1
Symptoms and Treatment
Symptoms of hypercalcemia include fatigue, weakness, increased thirst and urination, digestive issues, bone pain, and cognitive changes. Treatment depends on the underlying cause and may include addressing the primary condition, increasing fluid intake, medications like bisphosphonates or calcitonin to lower calcium levels, and in severe cases, hospitalization for intravenous fluids and medications 1.
Prevention and Management
Prevention and management of hypercalcemia involve avoiding hypercalcemia, particularly in patients with chronic kidney disease (CKD) stages G3a to G5D, and using a dialysate calcium concentration between 1.25 and 1.50 mmol/L (2.5 and 3.0 mEq/L) in patients with CKD stage G5D 1.
From the FDA Drug Label
Hypercalcemia associated with cancer The FDA drug label mentions hypercalcemia as a condition associated with cancer.
- The cause of high calcium mentioned is:
- Cancer 2
From the Research
Causes of High Calcium
- Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia, accounting for approximately 90% of cases 3, 4
- Malignancy is another major cause of hypercalcemia, with various mechanisms involved, such as production of parathyroid hormone-related protein (PTHrP) or activation of osteoclast degradation of bone 5, 6, 7
- Other causes of hypercalcemia include:
- Granulomatous disease, such as sarcoidosis 3, 4
- Endocrinopathies, such as thyroid disease 3
- Immobilization 3
- Genetic disorders 3
- Medications, such as thiazide diuretics and supplements, including calcium, vitamin D, or vitamin A 3
- Vitamin D toxicity 4
- Milk alkali syndrome 4
- Multiple myeloma 4
- Tuberculosis 4
- Chronic kidney disease 4
- Lymphoma 4, 7
- Sodium-glucose cotransporter 2 protein inhibitors 3
- Immune checkpoint inhibitors 3
- Denosumab discontinuation 3
- SARS-CoV-2 3
- Ketogenic diets 3
- Extreme exercise 3