Hypercalcemia – an underestimated medical problem

Abstract

Hypercalcemia affects approximately 1% of the worldwide population. This electrolyte abnormality is frequent both in out and inpatients (varies from 0,17 to 5% in hospitalized, however incidence increases even up to 7,5% in emergency departments in some populations). Primary hyperparathyroidism (PHPT) and hypercalcemia of malignancy (HCM), account for more than 90 percent of all causes of hypercalcemia. Other causes of hypercalcemia, such as vitamin D intoxication, granulomatous disorders, milk-alkali syndrome, medications, familial hypocalciuric hypercalcemia and immobilization amount to less than 10% of all causes of hypercalcemia. However, once primary hyperparathyroidism or cancer has been excluded, other causes of hypercalcemia, often life-threatening and requiring appropriate causal management, should be considered. Considering rare etiologies is important, nevertheless, when primary hyperparathyroidism or malignancy do not account for the hypercalcemia. The review describes patophysiology, symptoms and diagnostic approach to the most relevant causes of hypercalcemia.