Hypercalcemia, symptoms, differential diagnostics and treatment, or importance of calcium investigation

Česká verzia

Authors: Zdeněk Adam ¹; Karel Starý ²; Jozef Kubinyi ³; Kateřina Zajíčková ⁴; Zdeněk Řehák ⁵; Renata Koukalová ⁵; Miroslav Tomíška ¹; Martina Doubková ⁶; Jiří Prášek ⁷; Eva Pourová ⁸; Zdeňka Čermáková ⁹; Luděk Pour ¹; Marta Krejčí ¹; Viera Sandecká ¹; Eva Ševčíková ^9,10; Sabina Ševčíková ¹¹; Zdeněk Král ¹; Aleš Čermák ¹²
Authors place of work: Interní hematologická a onkologická klinika LF MU a FN Brno, pracoviště Bohunice ¹; Endokrinologikcká ambulance Interní gastroenterologické kliniky LF MU a FN Brno, pracoviště Bohunice ²; Ústav nukleární medicíny 1. LF UK a VFN v Praze ³; Endokrinologický ústav, Praha ⁴; Oddělení nukleární medicíny, centrum PET, RECAMO, Masarykův onkologický ústav, Brno ⁵; Klinika nemocí plicních a tuberkulózy LF MU a FN Brno, pracoviště Bohunice ⁶; Klinika nukleární medicíny LF MU a FN Brno, pracoviště Bohunice ⁷; Ordinace praktického lékaře pro dospělé Pustiměř ⁸; Oddělení klinické biochemie FN Brno, pracoviště Bohunice ⁹; Katedra laboratorních metod LF MU, Brno ¹⁰; Ústav patologické fyziologie LF MU, Brno ¹¹; Urologická klinika LF MU a FN Brno ¹²
Published in the journal: Vnitř Lék 2016; 62(5): 370-383
Category: Reviews

Summary

The concentration of calcium is carefully maintained under physiological conditions with parathormone, calcitonin and 1,25-dihydroxyvitamin D at appropriate levels. There are multiple causes that may bring about increased concentrations of calcium which exceed physiological values. Increased production of parathormone in parathyroid glands is only one of the possible causes. Malignant diseases are a very frequent cause of hypercalcemia, due to their creating mediators which stimulate osteoclasts and thereby osteolysis. A less frequent cause is represented by granulomatous processes, a typical example of which is sarcoidosis, whose cells increasingly (independently of parathormone) hydroxylate 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D. However there are also hereditary forms of hypercalcemia. One of the causes of the hereditary form of hypercalcemia is mutations of the calcium sensing receptor. In order to locate the adenoma of parathyroid glands, essential apart from sonographic imaging is scintigraphy ^99mTc-methoxyisobutylisonitrile (MIBI) and even more exact is PET-CT examination with a radio-pharmaceutical ¹⁸F-fluorocholine. PET-CT examinations are beneficial with regard to detecting a malignant cause of hypercalcemia in until then undetected malignancy or an undetected granulomatous process. The essential treatment procedures for malignant hypercalcemia include appropriate hydratation of ionic solutions without calcium, administering of bisphosphonates or denosumab. The text describes in detail the symptoms of hypercalcemia and diagnostics of causes of hypercalcemia.

Key words:
bisphosphonates – cinacalcet – denosumab – granulomatous diseases – hereditary hypercalcemia – hypercalcemia – hypercalciuria – hyperparathyreosis – calcimimetics – calcitonin – multiple myeloma – malignant hypercalcemia – parathormone – sarcoidosis – 1,25-dihydroxyvitamin D

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