Hypercalcemia

Ca >10.5 mg/dL

Presentation Primary PTH ↑

Hyperparathyroidism Phos ↓
Stones Bones Groans
Kidney Stones Bone Pain Abdominal Pain

Due to parathyroid
Thrones Psychiatric Overtones adenoma or hyperplasia

↑ Urinary Frequency Anxiety, Altered Mental Status

Malignancy PTH ↓ Granulomatous PTH ↓ Milk-Alkali PTH ↓

Disease Syndrome
Phos ↓ Phos ↑ Phos ↑

Usually due to PTHrP, ↑ 1-α-hydroxylase activity Excessive intake of

which increases resorption in epithelioid histioytes ⇒ calcium and antacid
of calcium from bone ↑ activated vitamin D (calcium carbonate)
Can be due to bone Also presents with
infiltration metabolic alkalosis and
renal impairment

Familial
Multiple Endocrine PTH ↑ PTH ↑
Treatment
Hypocalciuric
Neoplasia Syndrome
Phos ↓ Hypercalcemia Phos ↓

MEN 1: Parathyroid Increase urinary

Defective calcium-sensing
adenoma + pituitary tumor excretion with IV fluids
receptors ⇒ more calcium
+ pancreatic tumor If severe, consider
needed to suppress PTH
MEN 2A: Parathyroid bisphosphonates and/or
Differentiate from primary
hyperplasia + medullary calcitonin
hyperparathyroidism by
thyroid carcinoma + If granulomatous
hypocalciuria
pheochromocytoma disease, add steroids

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