Hypercalcemia

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Diagnosis

Hypercalcemia can cause few or no symptoms. So, you might not know you have it until routine blood tests show a high level of calcium. Blood tests also can show whether your parathyroid hormone level is high, which could be a sign of hyperparathyroidism.

If you have hypercalcemia, your healthcare professional looks for its cause. You might need imaging tests of your bones or lungs. This helps find out if the cause is a disease such as cancer or sarcoidosis.

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Treatment

If your hypercalcemia is mild, you might not need treatment right away. You and your healthcare professional may wait to see if symptoms start or become worse. Your bones and kidneys might be checked over time to be sure they stay healthy.

For hypercalcemia that is more serious, your healthcare professional might recommend medicines or treatment of the underlying disease. Sometimes, treatment includes surgery.

Medications

For some people, medicines such as these may be recommended:

  • Calcitonin (Miacalcin). This hormone from salmon controls calcium levels in the blood. Mild upset stomach can be a side effect.
  • Calcimimetics. This type of medicine can help control overactive parathyroid glands. Cinacalcet (Sensipar) has been approved to manage hypercalcemia.
  • Bisphosphonates. These osteoporosis medicines can quickly lower calcium levels when given through a vein (IV). Often, they're used to treat hypercalcemia due to cancer. Risks linked with this treatment include thigh fractures as well as breakdown of the jaw, called osteonecrosis.
  • Denosumab (Prolia, Xgeva). This medicine often is used to treat people with hypercalcemia caused by cancer who don't respond well to bisphosphonates.
  • Prednisone. Short-term use of steroid pills such as prednisone can help against hypercalcemia caused by high vitamin D levels.
  • IV fluids and loop diuretics. Very high calcium levels can be a medical emergency. You might need treatment with IV fluids in the hospital to quickly lower your calcium level. This helps prevent heart rhythm problems or damage to the nervous system. You also might need medicines called loop diuretics if your calcium level stays high. Or you might need them if too much fluid builds up in your body.

Surgical and other procedures

Conditions linked with overactive parathyroid glands often can be cured by surgery to remove the tissue that's causing the problem. In many people, only one of the four parathyroid glands is affected. Before surgery, a special scanning test involves getting a shot with a small amount of radioactive material. The material helps pinpoint the affected gland or glands.

Treatment of parathyroid disease at Mayo Clinic

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Why Choose Mayo Clinic

Parathyroid treatment

Travis J. McKenzie, M.D., Endocrine and Metabolic Surgery: Here at the Mayo Clinic in Endocrine and Metabolic Surgery, we treat the full spectrum of parathyroid problems and that ranges from the simplest primary hyperparathyroidism to the most complex cases.

Melanie L. Lyden, M.D., Endocrine and Metabolic Surgery: What they are are four little glands that regulate the calcium. And most often, it's just one of them that develops a tumor of it.

Dr. McKenzie: We utilize multimodal imaging, meaning various types of imaging to identify where the abnormal parathyroid is located. And that can include various imaging techniques such as ultrasound, parathyroid sestamibi scan, which is a nuclear medicine imaging. We use four-dimensional CT scan, which is an advanced CT scan imaging of the neck and parathyroid glands. And finally, cutting-edge imaging such as choline PET scan.

Trenton R. Foster, M.D., Endocrine and Metabolic Surgery: So PET choline is one of the newest imaging modalities that's out there. It requires a generation of a choline isotope onsite and so this is not widely available. It's really only available at a few centers across the country. And so with this type of scan, we can find parathyroid glands that are otherwise missed by traditional imaging techniques.

Dr. McKenzie: Once that step is complete, then the patient can very confidently move towards the next step, which is treatment.

Dr. Foster: Patients can come into the office feeling a variety of symptoms that are generally nonspecific but rather debilitating for them. In many of these cases, we're able to treat hyperparathyroidism and watch these symptoms literally go away.

Dr. McKenzie: What we strive for is really to have a very efficient and effective itinerary for our patients and know they're going to be operated on by very high-volume, experienced parathyroid surgeons. They feel confident that they're going to come here and get the care they need and deserve.

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More Information

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Preparing for your appointment

You might start by seeing your primary healthcare professional. Then you'll likely be referred to a doctor called an endocrinologist, who treats hormonal conditions.

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, make a list of:

  • Your symptoms. Include any that don't seem related to the reason for your checkup. Note when they began.
  • Key personal information. Include major stresses or recent life changes, your medical history, and your family's medical history.
  • All medicines, vitamins and other supplements you take. Include the amounts you take, called the doses.
  • Questions to ask your healthcare professional.

Take a family member or friend along if you can. That person can help you remember the information you're given.

For hypercalcemia, basic questions to ask your healthcare team include:

  • What's the most likely cause of my symptoms?
  • What tests do I need?
  • What treatments are available, and which do you recommend?
  • What side effects can I expect from treatment?
  • Are there treatment options other than the one that you're suggesting?
  • I have other health conditions. How can I best manage them together?

What to expect from your doctor

Your healthcare professional likely will ask you questions such as:

  • Does anything improve your symptoms?
  • What, if anything, makes your symptoms worse?
  • Have you had kidney stones, bone fractures or osteoporosis?
  • Do you have bone pain?
  • Do you have unexplained weight loss?
  • Have family members had hypercalcemia or kidney stones?
By Mayo Clinic Staff
Request an appointment
Symptoms & causesDoctors & departments
March 08, 2024
Print
  1. Shane E. Clinical manifestations of hypercalcemia. https://www.uptodate.com/contents/search. Accessed Oct. 18, 2023.
  2. AskMayoExpert. Hypercalcemia. Mayo Clinic; 2019.
  3. Hypercalcemia. Merck Manual Professional Version. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte-disorders/hypercalcemia. Accessed Oct. 18, 2023.
  4. Shane E, et al. Treatment of hypercalcemia. https://www.uptodate.com/contents/search. Accessed Oct. 18, 2023.
  5. Hypercalcemia of malignancy. Endocrine Society. https://www.endocrine.org/patient-engagement/endocrine-library/hypercalcemia-of-malignancy. Accessed Oct. 18, 2023.
  6. Ojbindra KC, et al. Unusual case of dehydration leading to severe symptomatic hypercalcemia. American Journal of Case Reports. 2022; doi:10.12659/AJCR.936204.

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Hypercalcemia