Elevated Calcium

Calcium elevated

Check PTH

PTH elevated

Primary hyperparathyroidism. Screen for MEN syndrome if < 30

Pre-op sestamibi-iodine subtraction scanning to locate adenoma

high resolution neck ultrasound

PTH low or low normal

Check PTHrP

PTHrP elevated

Hypercalcemia of malignancy likely proceed with cancer workoup: PET-scan, MRI with and without contrast to locate tumor.

PTHrP normal

Consider other causes: medications such as Lithium, Vitamin D, Antacids, Thiazide diuretics, Granulomatous disease: Sarcoidosis, TB, Hyperthyroidism

Check phosphate levels

Phosphate levels low

Check 24 hr urine

Will show hypercalciuria

KUB

May show kidney stones

DEXA Scan

May show osteoporosi

X-ray

May show decreased bone density

May show fragility fracture

EKG

Tall, peaked T waves, short QT interval, possible p wave disappearance, heart block, bradyarrythmias

Primary hyperparthyroidism

Hypercalemia of malignancy

Granulomatous disease

Drugs: thiazide diuretics, lithium, vitamin D intoxication

Adrenal insuffiency

Multiple Endocrine Neoplasia

Are you taking any of the following medications such as lithium, vitamin D, antacids, or thiazide diuretics?

Has anyone in your family experienced similar symptoms?

Have you been experiencing muscle pain on weakness?

Have you been experiencing any stomach pain or burning after eating?

Have you been experiencing any fevers or unexplained weight loss?

Have you been feeling any fatigue or symptoms of depression?

Hypertension

Proximal weakness

Palpitation

Abdominal Pain

Decreased Deept Tendon Reflexes

If labs show primary hyperparathyroidism then do a subtotal parathyroidectomy because the calcium is > 11.0 and the patient is experiencing symptoms such as constipation and hypertension.

Complications

Injury to recurrent laryngeal nerves

chronic hypocalcemia requiring life long calcium and vitamin D supplementation

Bisphosphonates to increase bone mineral density if low

Complications

Unwanted Side Effects

GI side effects: esophagitis and esophageal ulcers

Infusion reactions

Arthalagias/myaligias/bone pain

Osteonecrosis of the jaw

Atypical fractures