HypercalcemiaCalcium - elevated; High calcium level; Hyperparathyroidism - hypercalcemia
Hypercalcemia means you have too much calcium in your blood.
Parathyroid hormone (PTH) and Vitamin D help manage calcium balance in the body.
- PTH is made by the parathyroid glands. These are four small glands located in the neck behind the thyroid gland.
- Vitamin D is obtained when the skin is exposed to sunlight, and from food sources or supplements.
The most common cause of high calcium blood level is excess PTH released by the parathyroid glands. This excess occurs due to:
- An enlargement of one or more of the parathyroid glands.
- A growth on one of the glands. Most of the time, these growths are benign (not a cancer).
Calcium blood level may also be high if your body is low on fluids or water.
Other conditions can also cause hypercalcemia:
- Certain kinds of cancers, such as lung and breast cancer, or cancer that has spread to your organs.
- Too much vitamin D in your blood (hypervitaminosis D).
- Being immobile in bed for many days or weeks (mostly in children).
- Too much calcium in your diet. This is called milk-alkali syndrome. It most often occurs when a person is taking more than 2000 milligrams of calcium bicarbonate supplements a day along with high doses of Vitamin D.
- Overactive thyroid gland.
- Chronic kidney disease or kidney failure.
- Medicines such as lithium and thiazide diuretics (water pills).
- Some infections or health problems such as, Paget's disease, tuberculosis and sarcoidosis.
- An inherited condition that affects the body's ability to manage calcium.
Men and women of all ages can have a high blood calcium level. However, it is most common in women over age 50 (after menopause). In most cases, this is due to an overactive parathyroid gland.
The condition is most often diagnosed at an early stage using routine blood tests. Most people have no symptoms.
Symptoms due to high calcium level may vary, depending on the cause and how long the problem has been present. They may include:
- Digestive symptoms, such as nausea or vomiting, poor appetite, or constipation
- Increased thirst or more frequent urination, due to changes in the kidneys
- Muscle weakness or twitches
- Changes in how your brain works, such as feeling tired or fatigued or confused
- Bone pain and fragile bones that break more easily
Exams and Tests
An accurate diagnosis is needed in hypercalcemia. People with kidney stones should have tests to evaluate for hypercalcemia.
Treatment is aimed at the cause of hypercalcemia whenever possible. People with primary hyperparathyroidism (PHPT) may need surgery to remove the abnormal parathyroid gland. This will cure the hypercalcemia.
People with mild hypercalcemia may be able to monitor the condition closely over time without treatment.
In women who are in menopause, treatment with estrogen can sometimes reverse mild hypercalcemia.
Severe hypercalcemia that causes symptoms and requires a hospital stay may be treated with the following:
- Fluids through a vein -- This is the most important therapy.
- Dialysis, if kidney damage is involved.
- Diuretic medicine, such as furosemide.
- Drugs that stop bone breakdown and absorption by the body (bisphosphonates).
- Glucocorticoids (steroids).
How well you do depends on the cause of your high calcium level. The outlook is good for people with mild hyperparathyroidism or hypercalcemia that have a treatable cause. Most of the time, there are no complications.
People with hypercalcemia due to conditions such as cancer or sarcoidosis may not do well. This is most often due to the disease itself, rather than the high calcium level.
- Peptic ulcer disease
- Calcium deposits in the kidney (nephrocalcinosis) that cause poor kidney function
- High blood pressure
- Kidney failure
- Kidney stones
- Difficulty concentrating or thinking
These complications of long-term hypercalcemia are uncommon today in many countries.
When to Contact a Medical Professional
Contact your health care provider if you have:
- Family history of hypercalcemia
- Family history of hyperparathyroidism
- Symptoms of hypercalcemia
Most causes of hypercalcemia cannot be prevented. Women over age 50 should see their provider regularly and have their blood calcium level checked if they have symptoms of hypercalcemia.
Talk to your provider about the correct dose if you are taking calcium and vitamin D supplements.
Aronson JK. Vitamin D analogues. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier B.V.; 2016:chap 487-487.
Darr EA, Sritharan N, Pellitteri PK, Sofferman RA, Randolph GW. Management of parathyroid disorders. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 124.
Swan KL, Wysolmerski JJ. Hypercalcemia of malignancy. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 64.
Thakker RV. The parathyroid glands, hypercalcemia, and hypocalcemia. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 245.
Review Date: 2/22/2018
Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.