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Review
. 2010 Aug;22(4):508-15.
doi: 10.1097/MOP.0b013e32833b7c23.

Hypercalcemia in children and adolescents

Steven A Lietman  1 , Emily L Germain-Lee, Michael A Levine
Affiliations
Review

Hypercalcemia in children and adolescents

Steven A Lietman et al. Curr Opin Pediatr. 2010 Aug.

Abstract

Purpose of review: In this review, we define hypercalcemia levels, common causes for hypercalcemia in children, and treatment in order to aid the practicing pediatrician.

Recent findings: One rare cause of hypercalcemia in the child is familial hypocalciuric hypercalcemia (also termed familial benign hypercalcemia). Mutations that inactivate the Ca-sensing receptor gene FHH have been described as an autosomal dominant disorder, but recently milder mutations in the CASR have been shown to cause hypercalcemia when homozygous.

Summary: Normal serum levels of calcium are maintained through the interplay of parathyroid, renal, and skeletal factors. In this review, we have distinguished the neonate and infant from the older child and adolescent because the causes and clinical features of hypercalcemia can differ in these two age groups. However, the initial approach to the medical treatment of severe or symptomatic hypercalcemia is to increase the urinary excretion of calcium in both groups. In most cases, hypercalcemia is due to osteoclastic bone resorption, and agents that inhibit or destroy osteoclasts are, therefore, effective treatments. Parathyroid surgery, the conventional treatment for adults with symptomatic primary hyperparathyroidism, is recommended for all children with primary hyperparathyroidism.

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Figures

Figure 1
Figure 1. Hypercalcemia algorithm (54)
FeCa = Fractional (urinary) excretion of calcium Adapted from: Kelly A, Levine MA. Disorders of calcium, phosphate, parathyroid hormone and vitamin D. In: Kappy MS, Allen DB, Geffner ME editor. Pediatric Practice: Endocrinology. Springfield: Charles C. Thomas Publisher, LTD; 2009. p. 191-256.
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