The diagnosis and management of hypercalcaemia

Adapted from Minisola et al 26 Parathyroid hormone mediated Sporadic (adenoma, hyperplasia, or carcinoma) Familial (multiple endocrine neoplasia 1, 2a, or 4, hyperparathyroidism jaw tumour syndrome, familial isolated hyperparathyroidism, familial hypocalciuria hypercalcaemia) Ectopic parathyroid hormone in malignancy (rare) "Tertiary" hyperparathyroidism Malignancy Humoral hypercalcaemia of malignancy (parathyroid hormone related protein) Local osteolysis (cytokines, chemokines, parathyroid hormone related protein) Ectopic parathyroid hormone in malignancy (rare) Calcitriol related hypercalcaemia Vitamin D related Granulomatous disease (for example, sarcoidosis, tuberculosis, berylliosis, coccidiodomycosis, histoplasmosis, leprosy, inflammatory bowel disease, foreign body granuloma) Vitamin D intoxication (vitamin D supplements, metabolites, or analogues) Endocrine disorders Thyrotoxicosis Adrenal insufficiency Pheochromocytoma VIPoma (Verner-Morrison) syndrome Drugs Thiazide diuretics Lithium Milk-alkali syndrome (calcium and antacids) Vitamin A Parathyroid hormone Other Coexisting malignancy and primary hyperparathyroidism Immobilisation Acute renal failure Chronic renal failure treated with calcium and calcitriol or vitamin D analogues Renal transplant Parathyroid hormone mediated hypercalcaemia Parathyroid related causes of hypercalcaemia comprise primary (including the various genetic forms) and tertiary hyperparathyroidism. Different treatments need to be considered in people with hypercalcaemia from other causes, such as vitamin D intoxication or granulomatous disorders. Since in these cases, the underlying cause is an increased production of calcidiol, drugs that enhance vitamin D metabolism, such as glucocorticoids, are indicated.