Too much calcium
The cause of excess calcium in the body needs to be treated before it creates more serious complications.
YOU go for a routine health screen at your local clinic and your doctor tells you that your calcium level is higher than the normal range for healthy adults.
You are bewildered as you have not had any new or unusual symptoms, and you have not overdone your calcium supplements.
Is this something you can just ignore, or is it something that you need to take seriously?
A higher-than-normal calcium level in the blood, otherwise known as hypercalcaemia, is a frequently underdiagnosed condition.
This is as symptoms of this condition are usually either non-existent or mild, especially when the degree of calcium elevation is minimal.
I have encountered situations where patients have not been told about their raised calcium levels, even though it was detected on blood tests years before and noted in their records.
Some patients with high calcium levels experience symptoms, the severity of which usually corresponds to the level of calcium in the blood.
These symptoms include excessive thirst, frequent urination, nausea, vomiting and constipation.
Bone pain and confusion can also occur in patients with excessively high calcium levels.
Calcium levels in the bloodstream are usually tightly regulated by hormones in the body.
The typical normal range for calcium is 2.2 to 2.6 mmol/L, although normal values and reference ranges may vary between laboratories.
There are a number of situations when this regulation is disrupted, pushing the body’s calcium level out of its normal range.
These include overactive parathyroid glands (hyperparathyroidism), certain cancers, some diseases like tuberculosis and sarcoidosis, and excessive doses of calcium or vitamin D supplements above and beyond what is recommended.
Regardless of the cause, these elevated calcium levels need to be taken seriously and managed appropriately, with the best treatment option depending on the root cause of the hypercalcaemia.
This is as a number of complications can ensue as a result of the excessively high calcium levels if it is left untreated.
Among the common complications are osteoporosis, kidney stones, abnormal heart rhythms, damage to the kidneys, and problems affecting the nervous system, which can lead to a coma.
A treatable condition
A recent patient came to me for evaluation due to his persistently high blood calcium levels.
His hypercalcaemia had been picked up during routine medical check-ups since eight years ago, but he was not referred for further assessment and management until now.
Over the years, he has been experiencing increasing thirstiness, needing to drink more than three litres of fluid in a day.
He also needs to visit the toilet at least once or twice every hour during the day.
After a detailed assessment, which included further blood tests, an ultrasound of the kidneys and bone mineral density testing, he was found to have renal stones in both kidneys, chronic kidney disease and osteoporosis.
It is likely that these complications could have been prevented had he received earlier diagnosis and treatment of his hypercalcaemia.
One of the common causes of hypercalcaemia is a condition called primary hyperparathyroidism (which the patient above had).
This is when there is overactivity of one or more of the parathyroid glands (pea-sized glands that are on or near the thyroid gland in the neck).
This leads to raised levels of parathyroid hormone (PTH), which can be tested with a blood sample.
The previous estimate for new primary hyperparathyroidism patients on an annual basis used to be one to 10 per 100,000 persons.
However, this number has increased with the rise in health screening in recent years.
The specific treatment for primary hyperparathyroidism is decided on after a discussion between the patient and the doctor.
Several factors will have a bearing on the type of treatment, including the patient’s age, overall health status and other medical problems, as well as the extent of the disease.
The patient’s expectations regarding the course of the disease, as well as personal preferences, are also important to this decision.
Surgery to remove the affected gland or glands may be needed.
However, this may not always be possible or recommended, especially if the patient is older and frail, and the risks of surgery outweigh the potential benefits.
If surgery is not possible or not recommended, certain medical treatments may be suggested instead.
If you suspect that you or your family member may have this condition, do seek a consultation with an endocrinologist (a specialist who is trained to diagnose and treat hormone imbalances and problems).
Earlier detection and treatment can prevent the development of complications and help the patient achieve a better outcome.
Dr Chooi Kheng Chiew is a consultant endocrinologist at University Malaya Medical Centre. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.