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What is Hypercalcaemia?

Calcium is an important mineral present in our body. It helps in the muscle contraction, regulating the heartbeat and in the formation of blood clots. There are four pea-sized parathyroid glands which regulate the level of calcium in our body. These glands reside in the tissue of the thyroid gland, while detecting the fluctuation of the calcium levels in blood. The condition when the calcium levels increase in the blood is called as hypercalcaemia.

Usually, this sudden increase is the result of a cancer which has spread to the bones. Overproduction of PTH also results in the hypercalcaemia and is usually due to a tumor of parathyroid glands or when other calcium balancing mechanisms like kidneys, start malfunctioning. Hypercalcaemia results in abdominal pain, nausea and vomiting, fatigue, anorexia, pancreatitis, constipation, loss of appetite, excessive thirst, excessive passing of water, tiredness, weakness, weight loss and other more serious conditions like depression, dehydration, bone fractures, kidney stones and sudden heart attacks.

Causes of Hypercalcaemia

For the majority of cases of hypercalcaemia, hyperparathyroidism and malignancy are the resultant causes. There are many diseases which result in the manifestation of hypercalcaemia. These include abnormal parathyroid gland function, primary hyperparathyroidism, solitary parathyroid adenoma, primary parathyroid hyperplasia, parathyroid carcinoma, multiple endocrine neoplasia (MEN), familial isolated hyperparathyroidism, lithium use, familial hypocalciuric hypercalcaemia/familial benign hypercalcaemia, malignancy, solid tumor with metastasis (e.g. breast cancer), solid tumor with humoral mediation of hypercalcaemia (e.g. lung or kidney cancer, pheochromocytoma), ematologic malignancy (multiple myeloma, lymphoma, leukemia), vitamin-D metabolic disorders, hypervitaminosis D (vitamin D intoxication), sarcoidosis and other granulomatous diseases, idiopathic hypercalcaemia of infancy, rebound hypercalcaemia after rhabdomyolysis, disorders related to high bone-turnover rates, hyperthyroidism, prolonged immobilization, thiazide use, vitamin A intoxication, Paget's disease of the bone, renal failure, severe secondary hyperparathyroidism, aluminum intoxication, and milk-alkali syndrome among others.

How can Hypercalcaemia be Treated?

The first step of the treatment is to deal with the hypercalcaemia before dealing with the underlying cause. Depending on the severity of the disease, that is the level of calcium present in the blood, the treatment is decided upon. At times, no treatment at all is required. At times, use of surgery may be needed in order to remove the parathyroid gland, in case they are the root cause of hypercalcaemia. Since hypercalcaemia results in vomiting and nausea, one needs to get the patients hydrated, increase the intake of salt (which results in the increase of sodium in kidney leading to more excretion of calcium), and making use of diuretics (which work by depressing the renal calcium reabsorption). Biphosphonates and calcitonin are used because of their high bone affinity. Some of the available drugs are: (1st gen) etidronate, (2nd gen) tiludronate, IV pamidronate, alendronate, risedronate, and (3rd gen) zoledronate.

Cancer patients who have hypercalcaemia are also treated with biphosphonates, since if provided with any other therapy, it is quite certain that hypercalcaemia will recur. Biphosphonates, on the other hand, provide both the therapeutic and the preventive therapies.

However, patients with renal failure and hypercalcaemia should be analyzed completely before being administered biphosphonates because these are contraindicated in renal failure. Calcitonin helps in blocking the bone reabsorption and thus increases the excretion of calcium along with the urine.

It is usually used in severe cases of hypercalcaemia, administered along with the combination of rehydration, diuresis and biphosphonates. Some of the additional therapies used in treating the hypercalcaemia are: plicamycin (inhibits bone reabsorption), gallium nitrate (inhibits reabsorption and changes bone crystal structure), glucocorticoids (increase urinary calcium excretion, decrease intestinal calcium absorption), dialysis (used in case of renal failure), supplemental phosphate (phosphate therapy can correct hypophosphatemia when having hypercalcaemia and low serum calcium).

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