Hypercalcaemia - presentation and management

Abstract

Hypercalcaemia is a common disorder normally caused by primary hyperparathyroidism (PHPT) or malignancy. A proportion of cases present as an emergency, which carries a significant mortality. Emergency management of hypercalcaemia is based on intravenous rehydration with normal saline but when this is inadequate, bisphosphonate therapy is used; more recently the novel anti-resorbtive agent denosumab has been shown to have a useful role in treatment. It is estimated that up to 10% of all cases of PHPT presenting under the age of 45 years have an underlying genetic predisposition; nine potentially causative genes are now recognised and may be screened in routine clinical practice. Although parathyroidectomy is the only curative treatment for PHPT, this is indicated in a minority of cases. Many cases can be adequately managed conservatively and guidance from the 4th international workshop on the management of asymptomatic PHPT has recently been updated in a consensus statement.

Fig 1.

SPECT CT images of parathyroid adenoma. Fused (A) axial and (B) coronal SPECT CT images showing a superior left parathyroid adenoma adjacent to the oesophagus posterior to the left lobe of thyroid. Physiological uptake in the parotid glands is also seen. SPECT = single photon emission computerised tomography