A 50 Year Old Woman Presents With Long Standing Bone Pains.

A 50 year old woman who had a history of long standing body pains and aches , was found to have hypercalcemia on her blood reports. On further workup she also had high levels of parthyroid hormone. On further questioning she mentions that she frequently gets a stomach upset, with abdominal pain and constipation. She feels lethargic and has a feeling of lack of energy for a long time.

This patient was diagnosed to have Hypercalcemia secondary to Hyperparathroidism .

Case Discussion;

Hypercalcemia is a condition in which the calcium levels in the blood is above normal limits. By far the most common cause of hypercalcemia is hyperparthroidism, from the over activity or adenoma of parathroid glands.


Clinical features: Early in the course when there is mild hypercalcemia, patients may have no or very mild symptoms. Too much calcium in the body can weaken the bones, can lead to kidney stones and may interfere with the normal functioning of the brain.
Signs and symptoms include:

• Lethargy and weakness
• Confusion
• Polyuria and nocturia
• Dehydration
• Renal stones
• Constipation
• Nausea
• Anorexia
• Abdominal pain
• Gastric ulcer
• Bone pains. 

Complications: Long standing hypercalcemia may lead to:

1. Osteoporosis: when hypercalcemia is secondary to hyperparathroidism , high levels of parathyroid hormone stimulates the bone to release calcium into the blood. this leads to thinning and weakening of the bone, which may result in fractures on minor trauma, and loss of height. 

2. Kidney failure: Severe hypercalcemia can slowly damage the kidneys leading to kidney failure. 

3. Heart Arrhythmia: High levels of calcium ion the blood can alter the electrical impulses conducted in the heart muscle and may lead to arrhythmias. 

ECG characteristic of hypercalcemia is shown below:

Diagnosis: Since hypercalcemia may cause few or no symptoms it is sometimes diagnosed on routine blood work. Once found the underlying cause should be identified by doing the relevant workup including parthyroid hormone levels, urinary calcium excretion, thyroid function tests, imaging tests of bone and lungs etc. 

Treatment: The goal of therapy is to identify the underlying cause and treat accordingly. 

1. General management includes proper hydration which helps in preventing the formation of renal stones. 

2. Immobilization aggravates hypercalcemia, whenever possible weight bearing physical activity should be encouraged. 

3. Patients with calcium levels less than 12 mg/dl and with no symptoms does not need any specific treatment.

4. Patients who have high levels above 14 mg/dl along with symptoms of confusion may need aggressive treatment. 

5. Reduction of dietary calcium and vitamin D intake is effective as it helps in decreasing calcium absorption from the intestinal tract.

6. Bisphosphonates inhibit osteoclastic bone resorption and are effective in the treatment of hypercalcemia due to conditions causing increased bone resorption.

7. Prolonged hypercalcemia due to hyperparathyroidism may need surgical removal of parthyroid adenoma or one or more parathyroid glands.