eMedicine Specialties > Nephrology > Acid-Base, Fluid, and Electrolyte Disorders

Hypercalcemia: Follow-up

Author: Mahendra Agraharkar, MD, MBBS, FACP, FASN, Clinical Associate Professor of Medicine, Baylor College of Medicine, President & CEO, Space City Associates of Nephrology
Coauthor(s): O David Dellinger III, MD, Assistant Professor, Departments of Family Medicine and Internal Medicine, University of Alabama School of Medicine at Birmingham; Arun Kumar Gangakhedkar, FRACP, MD, Consultant, General Pediatrics, Starship Children's Hospital/Waitakere Hospital, Auckland, New Zealand
Contributor Information and Disclosures

Updated: Jul 27, 2009

Follow-up

Further Outpatient Care

  • In most cases, follow-up care is dictated by the etiology of hypercalcemia.
    • If the hypercalcemia is related to malignancy, the cause may be obvious in most cases and efforts are directed towards treating the neoplasm.
    • The role of oral phosphates in the treatment of hypercalcemia is limited and now is increasingly replaced by bisphosphonates. However, when phosphates are used, especially for treating chronic hypercalcemia, attention should be paid to hyperphosphatemia and the calcium and phosphate product because this tends to increase the risk of metastatic calcification.
    • Dietary restriction of calcium and glucocorticoid administration remains the preferred treatment for hypercalcemia due to sarcoidosis and vitamin D intoxication.

Miscellaneous

Medicolegal Pitfalls

  • Hypercalcemia frequently is undiagnosed.
    • All cases of hypercalcemia should be investigated.
    • Hyperparathyroidism often coexists with other, more serious problems.
    • Any sudden change or rise in calcium levels should trigger consideration for a more serious condition.
 


More on Hypercalcemia

Overview: Hypercalcemia
Differential Diagnoses & Workup: Hypercalcemia
Treatment & Medication: Hypercalcemia
Follow-up: Hypercalcemia
Multimedia: Hypercalcemia
References
Further Reading
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References

  1. McKay CP, Portale A. Emerging topics in pediatric bone and mineral disorders 2008. Semin Nephrol. Jul 2009;29(4):370-8. [Medline].

  2. Makras P, Papapoulos SE. Medical treatment of hypercalcaemia. Hormones (Athens). Apr-Jun 2009;8(2):83-95. [Medline]. [Full Text].

  3. Bergenfelz AO, Jansson SK, Wallin GK, et al. Impact of modern techniques on short-term outcome after surgery for primary hyperparathyroidism: a multicenter study comprising 2,708 patients. Langenbecks Arch Surg. Jul 18 2009;[Medline].

  4. Low TH, Clark J, Gao K, et al. Outcome of parathyroidectomy for patients with renal disease and hyperparathyroidism: predictors for recurrent hyperparathyroidism. ANZ J Surg. May 2009;79(5):378-82. [Medline].

  5. Padhi D, Harris R. Clinical pharmacokinetic and pharmacodynamic profile of cinacalcet hydrochloride. Clin Pharmacokinet. 2009;48(5):303-11. [Medline].

  6. Marcocci C, Chanson P, Shoback D, et al. Cinacalcet reduces serum calcium concentrations in patients with intractable primary hyperparathyroidism. J Clin Endocrinol Metab. Jun 2 2009;[Medline].

  7. al Zahrani A, Levine MA. Primary hyperparathyroidism. Lancet. Apr 26 1997;349(9060):1233-8. [Medline].

  8. Allerheiligen DA, Schoeber J, Houston RE. Hyperparathyroidism. Am Fam Physician. Apr 15 1998;57(8):1795-802, 1807-8. [Medline].

  9. Carroll MF, Schade DS. A practical approach to hypercalcemia. Am Fam Physician. May 1 2003;67(9):1959-66. [Medline].

  10. Falk S, Fallon M. ABC of palliative care. Emergencies. BMJ. Dec 6 1997;315(7121):1525-8. [Medline].

  11. Ganong CA, Kappy MS. Hypercalcemia. In: Berman S, ed. Pediatric Decision Making. 3rd ed. St. Louis, Mo: Mosby-Year Book; 1996:. 128-31.

  12. Hay WW Jr, Hayward AR, Levin MJ, Sondheimer JM, eds. Current Pediatric Diagnosis and Treatment. 14th ed. Stamford, Conn: Appleton & Lange; 1999:. 830-1.

  13. Hoenderop JG, Nilius B, Bindels RJ. Molecular mechanism of active Ca2+ reabsorption in the distal nephron. Annu Rev Physiol. 2002;64:529-49. [Medline].

  14. Inzucchi SE. Management of hypercalcemia. Diagnostic workup, therapeutic options for hyperparathyroidism and other common causes. Postgrad Med. May 2004;115(5):27-36. [Medline].

  15. Lteif AN, Zimmerman D. Bisphosphonates for treatment of childhood hypercalcemia. Pediatrics. Oct 1998;102(4 Pt 1):990-3. [Medline].

  16. Mundy GR, Guise TA. Hypercalcemia of malignancy. Am J Med. Aug 1997;103(2):134-45. [Medline].

  17. Pearce SH. Calcium homeostasis and disorders of the calcium-sensing receptor. J R Coll Physicians Lond. Jan-Feb 1998;32(1):10-4. [Medline].

  18. Postlethwaite RJ. Clinical Pediatric Nephrology. 2nd ed. New York, NY: Butterworth Heinemann; 1994.

  19. Renton P. Radiology of rickets, osteomalacia and hyperparathyroidism. Hosp Med. May 1998;59(5):399-403. [Medline].

  20. Rogers MJ, Watts DJ, Russell RG. Overview of bisphosphonates. Cancer. Oct 15 1997;80(8 Suppl):1652-60. [Medline].

  21. Sharma OP. Vitamin D, calcium, and sarcoidosis. Chest. 1996;109(2):535-539. [Medline].

  22. Strewler GJ. The physiology of parathyroid hormone-related protein. N Engl J Med. Jan 20 2000;342(3):177-85. [Medline].

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Further Reading

Related eMedicine topics:
Hypercalcemia [Emergency Medicine]
Hypercalcemia [Pediatrics: General Medicine]
Hypercalcemia and Spinal Cord Injury
Hyperparathyroidism [Emergency Medicine]
Hyperparathyroidism [Endocrinology]
Hyperparathyroidism [Otolaryngology and Facial Plastic Surgery]
Hyperparathyroidism [Pediatrics: General Medicine]
Hyperparathyroidism, Primary
Hyperparathyroidism, Secondary
Hypocalcemia [Emergency Medicine]
Hypocalcemia [Nephrology]
Hypocalcemia [Pediatrics: General Medicine]
Milk-Alkali Syndrome
Nephrocalcinosis [Nephrology]
Nephrocalcinosis [Radiology]
Parathyroid Adenoma
Parathyroid Carcinoma
Parathyroid Physiology
Williams Syndrome

Clinical guidelines:
Cinacalcet for the treatment of secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy. National Institute for Health and Clinical Excellence (NICE) - National Government Agency [Non-U.S.].  2007 Jan.  28 pages.  NGC:005508

The American Association of Clinical Endocrinologists and the American Association of Endocrine Surgeons position statement on the diagnosis and management of primary hyperparathyroidism. American Association of Clinical Endocrinologists - Medical Specialty Society
American Association of Endocrine Surgeons - Medical Specialty Society.  2005 Jan-Feb.  6 pages.  NGC:004187

Clinical trials:
Cinacalcet to Treat Hypercalcemia in Renal Transplant Recipients

One Week Parathyroid Hormone-Related Protein (PTHrP) IV Dose Escalation Study

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Keywords

hypercalcemia, parathyroid, hyperparathyroidism, serum calcium, Sensipar, high calcium levels, surgery parathyroid, parathyroidectomy, high serum calcium, calcium metabolism, excess calcium, calmodulin

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Contributor Information and Disclosures

Author

Mahendra Agraharkar, MD, MBBS, FACP, FASN, Clinical Associate Professor of Medicine, Baylor College of Medicine, President & CEO, Space City Associates of Nephrology
Mahendra Agraharkar, MD, MBBS, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Nephrology, and National Kidney Foundation
Disclosure: South Shore DaVita Dialysis Center  Ownership interest Other

Coauthor(s)

O David Dellinger III, MD, Assistant Professor, Departments of Family Medicine and Internal Medicine, University of Alabama School of Medicine at Birmingham
O David Dellinger III, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine
Disclosure: Nothing to disclose.

Arun Kumar Gangakhedkar, FRACP, MD, Consultant, General Pediatrics, Starship Children's Hospital/Waitakere Hospital, Auckland, New Zealand
Disclosure: Nothing to disclose.

Medical Editor

Frank C Brosius III, MD, Nephrology Program Director, Professor of Internal Medicine and Physiology, Department of Internal Medicine, Division of Nephrology, University of Michigan School of Medicine
Frank C Brosius III, MD is a member of the following medical societies: Alpha Omega Alpha, American Diabetes Association, American Society of Nephrology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Christie P Thomas, MBBS, FRCP, FASN, FAHA, Professor, Department of Internal Medicine, Division of Nephrology, University of Iowa Hospitals and Clinics; Director of Transplantation Services, Veterans Affairs Medical Center
Christie P Thomas, MBBS, FRCP, FASN, FAHA is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Heart Association, American Society of Nephrology, American Society of Transplantation, American Thoracic Society, International Society of Nephrology, and Royal College of Physicians
Disclosure: Genzyme Grant/research funds Other

CME Editor

Rebecca J Schmidt, DO, FACP, FASN, Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine
Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association
Disclosure: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching

Chief Editor

Vecihi Batuman, MD, FACP, FASN, Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System
Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology
Disclosure: Nothing to disclose.

 
 
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