Causes of Hypercalcemia - Differential Diagnosis Algorithm
• Primary Hyperparathyroidism
• Possible Familial Hypocalciuric Hypercalcemia
• Humoral Hypercalcemia of Malignancy
• Lymphoma, Granulomatous Disorders (eg sarcoidosis, tuberculosis)
• Vitamin D Intake
• Myeloma, Osteolytic Metastasis, Vitamin A, Thyrotropin
Dominique Tomacruz, MD @DTomacruzM
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Causes of Hypercalcemia
Hypercalcemia due to increased bone Ca2+ resorption:
• Primary hyperparathyroidism, Malignancy, Pseudohyperparathyroidism, Renal failure, Addison's disease, Hyperthyroidism, Immobilization
Hypercalcemia due to decreased urinary Ca2+ excretion:
• Familial hypercalcemic hypocalciuria, Thiazides
Hypercalcemia due to increased GI Ca2+ absorption:
• Granulomatous diseases (sarcoidosis, tuberculosis, coccidioidomycosis, histoplasmosis)
• Milk (calcium)-alkali syndrome
• Vitamin D intoxication
#Hypercalcemia #Causes #differential #diagnosis #calcium #high #endocrinology
Hypercalcemia - Differential Diagnosis Algorithm
Elevated PTH (High or normal):
• Primary Hyperparathyroidism
• Familial Hypocalciuric Hypercalcemia
Low PTH:
• Elevated Calcitriol (1,25 OH Cholecalciferol)
- ↑ 250H Cholecalciferol - Excess Vitamin D Intake
- ↓ 25OH Cholecalciferol - Granulomatous Disease, Lymphoma (Hodgkin)
• Elevated PTHrp
- Solid Tumors: Lung, SCC, renal, Bladder, Breast, Ovarian
- Leukemia/Lymphoma: NHL, CML
• Miscellaneous
- Bone Resorption: Hyperthyroid, Bony Mets
- Calcium Reabsorption: Thiazides/Lithium
#Hypercalcemia #Differential #Diagnosis #Algorithm #causes #endocrinology
Causes of Hypercalcemia
Parathyroid hormone–dependent
Primary hyperparathyroidism
Familial hypocalciuric hypercalcemia
Lithium-associated
Tertiary hyperparathyroidism
Genetic disorders (e.g., multiple endocrine neoplasia type 1 or type 2A, familial hyperparathyroidism)
Parathyroid hormone–independent
Renal failure, acute or chronic*
Neoplasms
- Parathyroid hormone–related protein dependent
- Osteolytic metastases and multiple myeloma
- Other humoral syndromes
Excess vitamin D
- Ingested or topical vitamin D analogues
- Granulomatous disease
- Williams syndrome
Other endocrine diseases: thyrotoxicosis, adrenal insufficiency
Drugs: vitamin A intoxication, milk-alkali syndrome, thiazide diuretics, theophylline
Other: immobilization, Jansen disease
#Hypercalcemia #Causes #Differential #Diagnosis #Endocrinology
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Causes of Hypercalcemia
Parathyroid gland structure-related
• Primary hyperparathyroidism
• Parathyroid adenoma
• Parathyroid hyperplasia
• Parathyroid carcinoma (may be part of multiple endocrine neoplasia)
Parathyroid gland function-related
• Lithium use
• Calcium-sensing receptor-gene mutations causing familial hypocalciuric hypercalcemia
Vitamin D metabolic disorders
• Excessive vitamin D intake
• Sarcoidosis (elevated 1,25-dihydroxy-vitamin D)
Increased bone turnover
• Immobilization
• Excessive vitamin A intake
• Hyperthyroidism
• Paget's disease of bone
Malignancy
• Hematological malignancies
• Multiple myeloma (bone turnover)
• Osteolytic metastases: thyroid, breast, lung, renal, adrenal, prostate (release of calcitriol, or PTHrP)
• Non-small-cell lung cancer
• Renal cell carcinoma
• Pheochromocytoma
Chronic kidney disease
• Tertiary hyperparathyroidism
• Aluminium intoxication
Dietary
• Milk-alkali syndrome
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