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Endocrinology

Hypercalcemia

Table of contents
Hypercalcemia
Calcium homeostasis
Anamnesis of a hypercalcemia
Physical inspection
Diagnostic testings
Diagnostic approach at inspection of the patient with a hypercalcemia
Differential diagnosis of the reasons of a hypercalcemia

Close concept: increase of concentration of calcium in blood serum

The hypercalcemia can be defined as increase of concentration of calcium in blood serum above the upper bound of the recommended level. The upper bounds of concentration of calcium recommended by different laboratories slightly differ from each other, and the most often quoted values are ranging from 8,5 to 10,5 mg of % (2,15 — 2,60 mmol/l). The specified distinctions are caused by the fact that in different laboratories different techniques of determination of concentration of calcium are used. In each separate case at an assessment of results of research it is necessary to be sure that rules of blood sampling were not violated and sample was taken after removal of a plait. Staz of a venous blood during a fence of test is a basic reason of a false hypercalcemia; it leads to increase of concentration of calcium due to ultrafiltration and exerts impact on concentration of protein in blood serum.

In this way false increase of concentration in blood of the general calcium can be observed at redistribution of liquid and protein in an organism owing to changes of position of a body (upon transition from horizontal position to vertical). The main fraction of protein which enters connection with calcium is the albuminous fraction. At an assessment of serumal concentration of calcium in clinical practice it is very important to define at the same time concentration in albumine blood serum. Simultaneous research of concentration in blood of crude protein and albumine in need of an assessment of concentration of calcium in dynamics during a long span is of especially great importance.

Prevalence of a hypercalcemia

There is a large number of the possible reasons of a hypercalcemia. Frequency of emergence of a hypercalcemia and pathophysiological value of the etiological factors leading to this state are still studied insufficiently. It is known what hypercalcemias, first of all hypercalcemias at a hyperparathyreosis, is quite widespread state which at many patients proceeds or asymptomatically, or has the erased symptomatology. Fisken and soavt. reported that they found clear distinctions in the frequency of emergence and the reasons of a hypercalcemia between the general population, and also the ambulatories and persons which came to a hospital. On the basis of the overview of literature authors came to conclusion that hypercalcemia frequency in the general population and among ambulatories fluctuates from 0,1 to 1,6%, and at patients of a therapeutic hospital makes from 0,5 to 3,6%. According to a number of messages, the most frequent reason of a hypercalcemia in the general population and among ambulatories is the hyperparathyreosis; other researchers report about rather high frequency of emergence of a hypercalcemia owing to use of diuretics from group of tiazid, at diseases of a thyroid gland, Burnett's syndrome (milk and alkaline), and also at a long immobilization. Malignant new growths meet among patients of a therapeutic hospital more often, than in the general population, and, according to the majority of messages, are the most common cause of a hypercalcemia.

Irrespective of category of patients the assessment and differential diagnosis of a hypercalcemia are carried always out on the basis of results of clinical inspection and critical evaluation of data of biochemical research. Diagnosis has to be based on deep understanding of the mechanisms participating in regulation of a homeostasis of calcium is normal, and nature of disturbances of these mechanisms at morbid conditions.



 
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