A CASE SERIES ON HYPERCALCEMIA

Abstract

Hypercalcemia in adults arises from a myriad of underlying causes. Etiology of hypercalcemia varies from causes like Vitamin D toxicity to hyperparathyroidism, hyperthyroidism, chronic kidney disease, granulomatous diseases, and malignant diseases .Though not an uncommon metabolic problem, hypercalcemia can easily be missed due to the diverse clinical presentations. Primary hyperparathyroidism and malignancy are the most common causes, accounting for 90% of the cases. Clinical manifestation varies depending on the ionized calcium levels. Symptoms manifest when calcium levels exceed 12 mg/dl. We report four different cases that illustrate the need for a focused workup of hypercalcemia. Routine hypercalcemia workup includes serum Parathormone (PTH), Vitamin D, ionized calcium, phosphorus, magnesium, alkaline phosphatase levels, renal functions, and urinary calcium-creatinine ratio. Prognosis depends on the cause of hypercalcemia. The clinical diagnosis needs a high index of suspicion. Denitive management requires focused workup for etiological diagnosis and treatment of underlying cause. Treatment for hypercalcemia is required in all symptomatic patients or if the calcium level exceeds more than 15 mg/dL, even if asymptomatic. Immediate management includes restoring intravascular volume and promoting diuresis. Calcitonin, Bisphosphonates and steroids play a role in medical management. For patient's refractory to medical treatment, hemodialysis is required.