High Calcium Level, To Ignore Or To Seek Help?

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 are unsure why this could be. There have been no new or unusual symptoms you’d noticed, and you had not taken excessive calcium supplements recently. Is this something you can just ignore, or is it something 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 usually because symptoms of this condition may be either non-existent or mild when the degree of calcium elevation is mild. I had encountered situations where patients had not been told regarding their raised calcium level even though it had been detected on screening tests years before, when their old records were scrutinised.

Some patients with high calcium levels experience symptoms, the severity of which usually corresponds to the level of calcium in the blood. Examples of 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 the calcium level 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 and the calcium levels are unable to maintained in the normal range. Possible causes for this include overactive parathyroid glands (hyperparathyroidism), certain cancers, some diseases like tuberculosis and sarcoidosis, or even excessive doses of calcium or vitamin D supplements above and beyond what was 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 because if left untreated, a number of complications can ensue as a result of the excessively high calcium levels in the blood. Among the common complications are osteoporosis, kidney stones, abnormal heart rhythms, damage to the kidneys and even problems affecting the nervous system, which may lead to coma.

A recent patient I had came to me for evaluation for persistently high blood calcium levels detected during his routine medical check-ups since 8 years ago, but had not previously been referred for further assessment and management. This patient had been having increasing thirst over the years, needing to drink more than 3 litres of fluid in a day and he had been needing to go to the toilet at least once or twice every hour during the day. After 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 he had also developed osteoporosis. It is likely that these complications could have been prevented had he received earlier diagnosis and treatment of the cause of the hypercalcaemia.

One of the common causes of hypercalcaemia (which the patient above had) is a condition called primary hyperparathyroidism, where 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 a raised level of parathyroid hormone (PTH), which can be tested with a blood sample. The previous estimate for new patients being diagnosed every year with primary hyperparathyroidism used to be in the order of 1 to 10 per 100,000 persons. However, this number had increased with the rise in health screening in recent years.

The specific treatment for primary hyperparathyroidism will be decided after a discussion between the patient and the healthcare provider. Several factors will have a bearing on the modality 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 may outweigh the potential benefits. If surgery is not possible or not recommended, certain medical treatments may be recommended instead.

If you suspect that you or your family members may have this condition, you may seek a consultation with an endocrinologist (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 to achieve a better outcome.

This article was previously published in The Star.

https://www.thestar.com.my/lifestyle/health/2020/09/08/too-much-calcium-in-my-blood