What are the other Names for this Condition? (Also known as/Synonyms)

• Adult Hypercalcemia
• Excess Blood Calcium in Adults
• Hypercalcaemia in Adults

What is Hypercalcemia in Adults? (Definition/Background Information)

• Hypercalcemia in Adults is characterized by elevated levels of calcium in blood in adults (individuals over the age of 18 years). The condition can affect both males and females, although it is more common among post-menopausal women
• Adult Hypercalcemia may be due to hyperparathyroidism (caused by a tumor or an enlargement affecting the parathyroid glands), excess ingestion of calcium or vitamin D, genetic mutation(s) in the CASR gene, genetic disorders interfering with calcium metabolism (such as Williams syndrome), sarcoidosis and certain cancers
• Depending on the severity, Hypercalcemia in Adults may not cause any symptom, may cause non-specific symptoms, or present with weakness, increased urination, dehydration, excessive thirst, constipation, and bone pain
• The primary method of treatment for Hypercalcemia in Adults is to facilitate excretion of calcium in urine through the use of diuretics. The treatment is based on the cause of the condition and may include the surgical removal of parathyroid gland tumor and prevention of bone loss, if needed
• The prognosis for Hypercalcemia in Adults is good, if it results from a benign and treatable condition. However, if increased calcium in blood occurs due to a serious illness, the outcome may be dictated by the severity of the underlying condition

Who gets Hypercalcemia in Adults? (Age and Sex Distribution)

• Hypercalcemia in Adults is rare, but may occur in individuals of any race or ethnicity
• Both genders may be affected by this condition. However, post-menopausal women over the age of 50 are more susceptible

What are the Risk Factors for Hypercalcemia in Adults? (Predisposing Factors)

The following are some known risk factors for Hypercalcemia in Adults:

• A genetic predisposition to hypercalcemia that can occur due to the following factors:
  • Mutation(s) in calcium sensing receptor gene CASR, that causes familial hypocalciuric hypercalcemia
  • Williams syndrome 
  • Jansen metaphyseal chondrodysplasia
  • Hypophosphatasia
• Hyperparathyroidism: Most cases of hypercalcemia in women are due to an overactive parathyroid gland
• Excess calcium in food
• Excessive vitamin D intake 
• Immobilization or bed rest due to an illness
• Cancer: Approximately, 10-20% of adults affected by cancer develop hypercalcemia
• Sarcoidosis: It is a systemic disease that can affect several parts of the body, leading to the growth of small lumps of inflammatory cells

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Hypercalcemia in Adults? (Etiology)

The major causes of Hypercalcemia in Adults include:

• Mutation(s) in calcium sensing receptor gene (CASR gene)
  • The CASR gene codes for calcium sensing receptor (CaSR)
  • This receptor, when activated, blocks the release of calcium into blood
  • Mutation(s) in the CASR gene lead to dysregulation of calcium metabolism, causing hypercalcemia
  • The gene mutation(s) are inherited in an autosomal dominant or recessive manner
• Certain genetic disorders that interfere with calcium metabolism (such as Williams syndrome)
• Primary hyperparathyroidism or an increase in parathyroid hormone (PTH), generally due to an enlargement or a benign growth or tumor (adenoma) in parathyroid glands. This elevation in PTH can lead to the following:
  • Increased osteoclastic bone resorption, causing increased release of calcium from bone to blood
  • Decreased serum phosphate
  • Increased activation of vitamin D
• Endogenous vitamin D intoxication due to excessive ingestion of vitamin D, whose active form can cause the following:
• Increased calcium resorption in kidneys
• Increased mineralization of bones
• Increased calcium absorption in the intestines
• Inactivity due to an illness: In inactive or bedridden individuals, decreased bone formation with corresponding increase in release of calcium in blood may result in this condition
• Presence of malignant tumors, which can cause:
  • Bone invasion causing mineralization
  • Secrete factors that circulate in blood (such as parathyroid hormone related peptide or PTHrP) and cause increased release of calcium from bones to blood
• Chronic vitamin A ingestion, leading to increased release of calcium into blood from bones
• Sarcoidosis
• Overactive thyroid gland
• Chronic kidney disease and kidney failure

What are the Signs and Symptoms of Hypercalcemia in Adults?

The signs and symptoms of Hypercalcemia in Adults may be non-specific in the initial stages. The type and severity of signs and symptoms may depend not only on the levels of calcium in blood, but also on how rapidly these levels increase, and the underlying condition associated with it. The signs and symptoms of Adult Hypercalcemia may include:

• Poor appetite
• Dehydration
• Frequent urination; excessive thirst
• Constipation
• Bone inflammation, bone lesions, and bone pain
• Low muscle tone; muscle weakness in upper limbs
• Calcium deposit in kidneys; formation of kidney stones
• Disuse osteoporosis or loss of bone mass due to immobility
• Irregular heartbeats
• Episodes of fainting
• Weakness, lethargy
• Confusion
• Seizures, in rare cases

How is Hypercalcemia in Adults Diagnosed?

Hypercalcemia in Adults is diagnosed on the basis of the following tests and exams:

• A complete physical examination 
• Assessment of signs and symptoms, when symptoms are present. It has to be noted that clinically significant symptoms may not be reported, since they can be vague during the initial stages of the condition
• Evaluation of personal and family medical history
• Blood tests to check for serum calcium levels; an adult is determined to be hypercalcemic, if serum calcium levels are above 10.5 mg/dL
• Blood tests to check for levels of parathyroid hormone, PTH-related protein, vitamin D, and phosphate
• Urine test to assess excreted calcium levels
• Additional tests, pertaining to causative conditions that led to Adult Hypercalcemia may be necessary for an accurate diagnosis and treatment

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Hypercalcemia in Adults?

The potential complications of long-term Hypercalcemia in Adults include:

• Loss of bone mass, leading to weak bones that are prone to easy fractures
• Death of bone tissue (osteonecrosis)
• Pancreatitis or inflammation of pancreas
• Stomach ulcers
• High blood pressure
• Cardiovascular collapse, causing sudden loss of blood flow to the brain and other organs
• Inability to think clearly
• Depression

How is Hypercalcemia in Adults Treated?

The treatment for Hypercalcemia in Adults may include the following measures:

• Increase excretion of calcium with infusion of saline and diuretics (such as furosemide)
• Calcitonin injection: Calcitonin increases excretion of calcium in urine and decreases loss of calcium from bones
• Nitrogen-containing bisphosphonates, such as pamidronate, to prevent calcium loss from bones and osteoporosis
• Glucocorticoid treatment in individuals with excess vitamin D
• If the cause of hypercalcemia is a tumor in the parathyroid gland, then surgery to remove the tumor is recommended
• Dialysis for kidney dysfunction
• Additional treatment methods pertaining to the underlying condition that caused Adult Hypercalcemia may be necessary

How can Hypercalcemia in Adults be Prevented?

• If Hypercalcemia in Adults occurs as a consequence of genetic mutation(s) in the CASR gene or other genetic disorders, there are no methods or guidelines for its prevention at the present time
• Regular medical screening at periodic intervals with tests and physical examinations are strongly recommended for women over the age of 50 to detect the condition early in its development
• Consulting a healthcare provider for proper dosage of calcium and vitamin D supplements is highly recommended
• Undertaking adequate treatment of pre-existing conditions that may lead to hypercalcemia is essential in maintaining normal levels of calcium in blood

What is the Prognosis of Hypercalcemia in Adults? (Outcomes/Resolutions)

• The prognosis of Hypercalcemia in Adults is good, if it occurs as a result of a benign and treatable condition 
• If the levels of calcium in blood rise quickly to abnormal high levels, serious complications that may be life-threatening, may occur
• In general, the overall outcome of Adult Hypercalcemia may be determined by the severity of the underlying causative condition and its response to treatment

Additional and Relevant Useful Information for Hypercalcemia in Adults:

Calcium is an important mineral for several cellular functions, which ultimately impact the whole body. Calcium is involved in the following functions in the body:

• Cell-cell communication
• Muscle contraction
• Conduction of nerve signals
• Activation of enzyme cascades
• Blood clotting, since calcium is also known as coagulation factor IV, and is required for certain enzymes in the clotting cascade to work effectively
• Exocrine secretions such as bile and pancreatic juice