What Causes Hypercalcemia?

What is Hypercalcemia? 

Hypercalcemia is a common clinical condition that can lead to chronic, moderate or mild levels of calcium in the blood. Many cases of hypercalcemia are caused by hyperparathyroidism (HPT) or malignancy. The condition affects all areas of the body, however, in mild cases, some areas – like the brain – are less affected, if at all. 

Our entire physical system functions because of a precise balancing act. It relies on vitamins, minerals, calories, hormones and more to keep our hearts pumping, our digestive tract running and even our circadian rhythm in a specific cycle. Calcium plays a vital role in supporting bodily functions. Without it, our bones can grow weak, our metabolisms can slow and many other systems can fail to function at peak performance. An imbalance in blood calcium levels, whether they are too low or too high, can throw off the heart rate, nervous system, wound healing and more. 

Hyperparathyroidism and Causes of Hypercalcemia 

Hypercalcemia and hyperparathyroidism often go hand in hand, meaning that a patient wouldn’t be able to solve hypercalcemia without first treating HPT.  Hyperparathyroidism is a generalized disorder that happens when the thyroid glands secrete too much parathyroid hormone. It’s the most common cause of hypercalcemia. Other causes of hypercalcemia can be: 

• Hyperparathyroidism. When parathyroid glands get triggered, they secrete hormones that regulate everything from sleep to digestion to sex drive. Primary hyperparathyroidism is one of the main causes of hypercalcemia and can be caused by issues within the endocrine system such as autoimmune disorders. Hypercalcemia is just one of the byproducts of this endocrine issue and can also be linked to other thyroid disorders. 
• Malignancy/Cancer. In many instances, patients hospitalized for cancer can develop hypercalcemia. Breast cancer, ovarian cancer or renal cancer are some of the more common types of cancer that can cause hypercalcemia.  
• Idiopathic Infantile Hypercalcemia. This very rare sporadic disorder often causes dysmorphic facial features, heart abnormalities and hypercalcemia.  
• Vitamin D toxicity. Too much vitamin D in the system can cause the bones and intestinal tract to reabsorb calcium, leading to a deficiency. Vitamin D toxicity can be triggered by lymphoma, tumors, T-cell leukemia or other severe illnesses.
• Taking too much calcium. When an individual takes calcium supplements or ingests a large amount of calcium over a period of time, their body may experience high calcium levels that can be classified as hypercalcemia. According to the Cleveland Clinic, women under the age of 50 and men under the age of 70 should aim to ingest 1000mg of calcium per day. After those ages, they should up their intake to 1,200mg of calcium. This can come in a variety of forms either through drink, food or supplements. An individual unaware of their calcium intake may take too much and cause damage. 
• Lung diseases like sarcoidosis or tuberculosis. Tuberculosis or sarcoidosis patients may experience excessive levels of calcium in the blood due to excessive extra-renal 1-alpha hydroxylase activity. They must manage vitamin D and calcium intake to ensure hypercalcemia is managed. 
• Immobilization. Patients who are on bed rest can have elevated levels of calcium in the blood. While this is an uncommon cause, it can present in individuals of all ages after an injury while a patient is bedridden.   
• Milk-alkali syndrome. Initially, doctors used a combination of milk and sodium bicarbonate to treat stomach ulcers, which would often drive up the calcium levels in a patient’s bloodstream. As this treatment fell by the wayside, this cause of hypercalcemia also declined. However, as the availability of over the counter calcium carbonate treatments increased, milk-alkali syndrome also increased. 
• Hereditary factors. A rare but severe cause of hypercalcemia is related to a genetic disease called familial hypocalciuric hypercalcemia. It sets in early, has almost no symptoms, and also presents elevated levels of magnesium in the body. 
• Severe dehydration. Water is needed to regulate many systems in the  body, such as the kidneys and liver, that filter out excess vitamins and minerals. Severe dehydration can lead to mild or moderate instances of hypercalcemia, which tend to subside as a patient becomes hydrated. 
• Medications. Lithium and other mood disorder-related drugs can trigger the release of the parathyroid hormone, which can increase one’s risk of HPT and thus, hypercalcemia. 

Symptoms of Hypercalcemia. 

The symptoms of hypercalcemia may be hard to spot depending on its severity. Mild hypercalcemia doesn’t usually show many symptoms whereas chronic or severe hypercalcemia can present very deadly symptoms.

• Moderate to severe hypercalcemia can present the following symptoms: 
  • Excessive thirst. The kidneys need to work harder to filter out excess calcium, thus causing the body to often crave more water.
  • Frequent urination. The same goes for frequent urination. Because the individual is likely drinking more water, needing to urinate much more than normal may be a sign of hypercalcemia. 
  • Upset stomach, including nausea, vomiting, diarrhea. 
  • Abdominal pain. 
  • Bone pain.
  • Muscle weakness.
  • Confusion. Because the brain relies on a precise chemical balance, too much or too little calcium can cause confusion, mental fatigue and brain fog. 
  • Dizziness.
  • Fatigue. 
  • Lethargy.
  • Kidney stones. 
  • Constipation. 
  • Heart palpitations.
  • Fainting.
  • Cardiac arrhythmia.

It can be difficult to identify hypercalcemia symptoms on your own. Many of the signs can look like symptoms for other common ailments or diseases, including general aging. However, knowing your baseline and your normal can help you identify what is abnormal and prompt you to consult with your doctor.  

Hypercalcemia Complications.

The risk of hypercalcemia isn’t necessarily immediate, however, when caused by underlying issues, like HPT or a pulmonary disease, it has a greater risk to cause severe health complications. 

• Kidney failure. To process excess calcium, your kidneys are working overtime. You may not notice this if you already are a frequent water drinker. However, acute kidney failure is a life-threatening situation that demands immediate dialysis and a possible kidney transplant. 
• Osteoporosis. Too much calcium is actually a bad thing and is counterproductive to bone health. Overtime, excess calcium in the bloodstream can actually weaken the bones.  
• Nervous System Issues. Your nervous system may start to go haywire with too much calcium in the bloodstream for too long. Muscle spasms, cramps, irritability, fatigue and more can result from hypercalcemia. This is especially dangerous as the nervous system is the link between body and brain, regulating daily bodily functions, like breathing and digestion. 
• Brain complications. Confusion, fatigue and depression can have severe impacts on one’s daily life, including familial relationships, work and hobbies. If left untreated, depression can result in a host of other mental health and physical health conditions.  

How to Prevent Hypercalcemia. 

Hypercalcemia can vary in severity but should be treated immediately. Hypercalcemia is a result of other disorders and is often diagnosed because a team of doctors are already aware of your medical condition. An endocrinologist who is working with you for a thyroid condition may already be aware of hypercalcemia and would be able to work with your primary care doctor to prevent hypercalcemia. 

UCF Health is easily able to connect you with a doctor in your area so you may start establishing a rapport and getting your health on track. From lifestyle medicine doctors to internists, our network of skilled care providers is vast and varied. 

Our patient portal also offers a plethora of healthy living tips, an online scheduling tool and COVID-19 updates for patients. Regular meetings with your primary care provider or internal medicine doctor paired with maintaining an active lifestyle are key to staying healthy and decreasing the risk of preventable instances of hypercalcemia.