elevated calcium

[TWR]

I have an 82 y/o neighbor with a chronic elevated calcium which over 2 years has creeped up to 14.6 It was slightly above normal 2 years ago. Multiple blood tests and scans have all been negative. No tumors etc.. Any thoughts on this. She is not taking any calcium supplements. Thanks for any thoughts.

[SocialMedicine]

what do you mean by no tumors ? the patient had pan scanning done ? is prostate cancer associated with elevated calcium I know certain breast and lung cancers are ? lab work I am sure checked PTH ? What about the adjusted value given his albumin ? vitamin D toxicity .. it is the trend now after all .. she could be taking this through multiple sources and be unaware ? You checked PTH related peptide? What medications is he on any thiazide diuretic or other vitamins ?

[SocialMedicine]

based on her personal and family history I would be considering breast MRI/mammogram, and lung CT scan lung CA protocol for this patient.

[d2305]

mary hyperparathyroidism and malignancy account for about 90% of cases of hypercalcaemia.^[6][7]

[h=3]Abnormal parathyroid gland function[edit source | editbeta][/h]

• primary hyperparathyroidism
  
  • solitary parathyroid adenoma
    
  • primary parathyroid hyperplasia
    
  • parathyroid carcinoma
    
  • multiple endocrine neoplasia (MEN)
    
  • familial isolated hyperparathyroidism^[8]
    

   

  [*]lithium use

  [*]familial hypocalciuric hypercalcaemia/familial benign hypercalcaemia^[9][10][11]

[h=3]Malignancy[edit source | editbeta][/h]

Micrograph of ovarian small cell carcinoma of the hypercalcemic type. H&E stain.

 

• solid tumour with metastasis (e.g. breast cancer or classicallysquamous cell carcinoma, which can be PTHrP-mediated)
  
• solid tumour with humoral mediation of hypercalcaemia (e.g.lung cancer, most commonly non-small cell lung cancer^[12] orkidney cancer, phaeochromocytoma)
  
• haematologic malignancy (multiple myeloma, lymphoma,leukaemia)
  
• ovarian small cell carcinoma of the hypercalcemic type
  

[h=3]Vitamin-D metabolic disorders[edit source | editbeta][/h]

• hypervitaminosis D (vitamin D intoxication)
  
• elevated 1,25(OH)₂D (see calcitriol under Vitamin D) levels (e.g. sarcoidosis and other granulomatous diseases)
  
• idiopathic hypercalcaemia of infancy^[13]
  
• rebound hypercalcaemia after rhabdomyolysis
  

[h=3]Disorders related to high bone-turnover rates[edit source | editbeta][/h]

• hyperthyroidism
  
• prolonged immobilization
  
• thiazide use
  
• vitamin A intoxication
  
• multiple myeloma
  

[h=3]Renal failure[edit source | editbeta][/h]

• severe secondary hyperparathyroidism
  
• aluminium intoxication
  
• milk-alkali syndrome