aetiology of hypercalcaemia
Last reviewed 04/2022
The common causes of hypercalcaemia which accounts for about 90% of cases are due to primary hyperparathyroidism and malignancy:
- primary hyperparathyroidism – commonest cause in the community (1), accounts for 80% of cases and is more important in the young
- malignancy accounts for 20-30% of cases (1) and is frequently accompanied by hypoalbuminaemia:
- suggested by rapidly increasing hypercalcaemia (1)
- metastases with osteolytic deposits e.g. breast
- osteoclast activating factors e.g. multiple myeloma
- ectopic parathyroid hormone like peptide e.g. hypernephroma, ovarian tumour, bronchial carcinoma
- 10-15% of hypercalcaemia caused by malignancy have associated hyperparathyroidism (2)
Rarer causes of hypercalcaemia include:
- increased extrarenal synthesis of calcitriol in chronic granulomatous disease:
- sarcoidosis
- pulmonary tuberculosis
- berylliosis
- Addison's disease
- Paget's disease with bed rest
- immobilisation - especially in adolescence when bone turnover is increased
- vitamin A and/or D toxicity
- drugs:
- thiazide diuretics
- lithium
- thyrotoxicosis:
- usually mild and accompanied by hypercalciuria
- due to increased bone turnover
- familial hypocalciuric hypercalcaemia
- tertiary hyperparathyroidism
- milk alkali syndrome
- multiple endocrine neoplasia (MEN) (2,3)
Reference:
- (1) Joshi D, Center JR, Eisman JA. Investigation of incidental hypercalcaemia. BMJ. 2009;339:b4613
- (2) Barth, J.H., Butler, G.E. and Hammond, P.J. 2008. Hypercalcaemia. Biochemical Investigations in Laboratory Medicine. Leeds Teaching Hospitals.
- (3) Carroll MF, Schade DS. A practical approach to hypercalcemia. Am Fam Physician. 2003;67(9):1959-66
PHP (primary hyperparathyroidism)
parathyroid hormone related peptide