We all know how important calcium is for the body, especially for our bones. Since childhood, our mothers have been telling us that "drinking milk strengthens bones." But have you ever thought about what happens if this so-called good calcium increases too much in our blood? That is what we call hypercalcemia in medicine. Today, we will talk about this very simply, in a way that you can understand.
What exactly is hypercalcemia?
Simply put, hypercalcemia is when you have more calcium in your blood than is normal. This can be a temporary, small increase, or it can be a chronic, life-long condition.
Now you might be wondering what happens when the calcium in your bones gets into your blood. Actually, most of the calcium in your body is in your bones. But for healthy functioning, you also need to have some calcium in your blood.
Here are the things that calcium in the blood does to our body:
- Proper functioning of the nervous system: This helps with everything we think, feel, and command.
- Muscle contraction: Calcium in the blood helps the muscles to move, walk, and perform any movement.
- Blood clotting: Helps stop bleeding when there is an injury.
- Proper functioning of the heart: This is essential to maintain the proper rhythm of the heart beat.
Our body regulates this calcium level in a very amazing way. Two hormones help in this. One is the parathyroid hormone, and the other is calcitonin. Vitamin D also plays a big role here, because vitamin D helps the body absorb calcium from the foods we eat.
However, due to certain diseases, medications, and other factors, this control system can become disrupted and the calcium level in the blood can increase. This is when hypercalcemia occurs.
The difference between Hypercalcemia and Hypocalcemia
Although these two words sound the same, their meanings are completely different.
- Hyper: The English word "Hyper" means "too much." That means hypercalcemia is an increase in calcium in the blood.
- Hypo: The word "Hypo" means "low." That means hypocalcemia is a low level of calcium in the blood.
Who is most likely to develop this condition?
Hypercalcemia can occur at any age, in anyone. However, women over 50 years of age , especially after menopause, are more likely to develop this condition. The main cause of this is an overactive parathyroid gland.
It is estimated that between 1% and 2% of the general population has this condition. However, 90% of these are caused by the previously mentioned problem with the parathyroid glands (primary hyperparathyroidism) or cancer.
Most of the time, this condition is not that serious. Many people are diagnosed with it by chance during a routine blood test done for another reason. So there is no need to worry.
However, if the calcium level in the blood becomes very high, it can cause serious problems.
- Kidney failure
- Abnormal heartbeat (Arrhythmia)
- Memory and consciousness disturbances (Confusion)
- Going into a coma
What are the symptoms of hypercalcemia?
Because this condition is often caught early, many people do not experience any symptoms. However, when calcium levels are slightly high or if the condition has been present for a long time, the following symptoms may occur.
| Body system | Possible symptoms |
|---|---|
| Kidneys and urinary system | Frequent urination and excessive thirst. |
| Digestive system | Nausea and vomiting, constipation, loss of appetite. |
| Brain and mental state | Forgetfulness, depression, frequent anger. |
| Bones and muscles | Bone pain, muscle pain, body aches, muscle twitching. |
| General characteristics | Constant fatigue and headaches. |
Why does calcium in the blood increase like this?
There are more than 25 diseases that can cause hypercalcemia. Some medications and dehydration can also cause it. But as we mentioned earlier, the two main causes are hyperparathyroidism and cancer.
1. Parathyroid gland problem (Primary Hyperparathyroidism)
There are four small glands in our neck, behind the thyroid gland. These are called the parathyroid glands. These produce parathyroid hormone (PTH). This hormone is the main one that controls the level of calcium in the blood.
Imagine, when our blood calcium levels drop, these glands release the hormone PTH. That hormone goes and releases some calcium from the bones into the blood, stops the kidneys from releasing calcium, and helps the intestines absorb calcium. In this way, calcium levels are brought back to normal.
However, if one or more of these four glands become overactive , even if the blood calcium level returns to normal, the PTH hormone will not stop being released. Then calcium from the bones will continue to be added to the blood, causing the blood calcium level to rise.
2. Cancers
About 2% of cancers are associated with hypercalcemia. Hypercalcemia of malignancy often occurs rapidly and can be severe. This is because some cancer cells produce a protein (PTHrP) that acts like the hormone PTH or release calcium by damaging bone.
Types of cancer that can cause this condition:
- Lung cancer
- Breast cancer
- Multiple myeloma (a cancer of the white blood cells)
- Renal cell carcinoma
- Blood cancer (Leukemia)
- Lymphoma (cancer of the lymphatic system)
3. Some medications
Some medications and vitamins we take can also cause this.
- Thiazide diuretics (medicines for high blood pressure), such as hydrochlorothiazide .
- Lithium ( a medication used to treat certain mental illnesses).
- Taking too much vitamin D, vitamin A, or calcium supplements .
Some people regularly take calcium carbonate tablets, such as Tums®, for gastritis. Taking too much of these can temporarily increase calcium levels in the blood.
4. Other reasons
In addition to this, there are several other rare reasons:
- Lung diseases such as sarcoidosis and tuberculosis.
- Kidney failure.
- Hyperthyroidism (Thyrotoxicosis).
- Immobilization.
- Bone diseases such as Paget's disease of the bone.
How to recognize this condition?
This is often detected with a simple blood test. Your doctor will measure your calcium levels during a basic metabolic panel (BMP) or comprehensive metabolic panel (CMP) blood test.
The severity of the condition is classified according to the level of calcium in the blood.
| Status | Blood calcium level (mg/dL) |
|---|---|
| Mild hypercalcemia | 10.5 to 11.9 mg/dL |
| Moderate hypercalcemia | 12.0 to 13.9 mg/dL |
| Severe/emergency situation (Hypercalcemic crisis) | 14.0 to 16.0 mg/dL |
When your doctor finds out that your blood calcium level is high, he or she will ask you about your medications, family medical history, and other things. Then, they will order a few more tests to find the cause.
- A blood test that checks parathyroid hormone (PTH) levels.
- A blood test to check vitamin D levels.
- A test that measures how much calcium is excreted in the urine.
If there is a suspicion that the cause is a problem with the parathyroid glands, an ultrasound scan or CT scan may be ordered to check for a tumor or swelling in the glands.
What are the treatments for hypercalcemia?
Treatment depends on the cause of the condition and its severity.
For mild cases
If your calcium levels are slightly elevated, your doctor may advise you to:
- Drink plenty of water: This helps flush out some of the excess calcium through the kidneys.
- Changing your medication: If you are taking thiazide-type medications for high blood pressure, you may be asked to change them.
- Stop taking supplements: If you are taking calcium pills, vitamin D, or gastritis pills, stop taking them or reduce the dosage as directed by your doctor .
If there is a problem with the parathyroid gland
If the cause is an overactive parathyroid gland, the best treatment is often surgical removal of the overactive gland or glands.
If the condition is caused by cancer
At this time, special medications are given to control calcium levels while treating the cancer.
- Bisphosphonates: These reduce the release of calcium from bones.
- Denosumab: This drug is given to people who do not respond to bisphosphonates.
For severe cases
If calcium levels are very high and severe symptoms are present, the patient should be hospitalized immediately for treatment. This involves giving saline intravenously (IV fluids) to quickly flush out the excess calcium from the body.
What are the long-term effects of this condition?
If hypercalcemia is not diagnosed and treated early, it can lead to long-term complications.
- Kidney stones .
- Kidney failure due to calcium deposits in the kidneys.
- High blood pressure (Hypertension) .
- Osteoporosis and increased risk of fractures.
- Bone cysts.
- Depression.
Can this situation be prevented?
Hypercalcemia cannot be prevented from all causes. However, you can reduce your risk to some extent by avoiding excessive calcium supplements and antacids containing calcium without medical advice .
If anyone in your family has a history of high blood calcium, kidney stones, or parathyroid disease, talk to your doctor about it.
Take-Home Message
- Hypercalcemia simply means that the amount of calcium in the blood is higher than the normal level.
- In most cases, mild cases do not show any symptoms. It is discovered through a random blood test.
- The two main causes of this are hyperactivity of the parathyroid glands and some types of cancer.
- Treatment options depend on the cause and severity of the condition, so an accurate diagnosis is very important.
- If you have any of the symptoms mentioned in this article or if someone in your family has had this disease, be sure to see your doctor for advice.
- Never use calcium or other vitamin supplements without medical advice.
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