Hypercalcemia:
Sequoia Medical 360

Find the Cause. Protect Kidneys, Brain, and Bone.

Hypercalcemia can be silent—or present with fatigue, thirst, frequent urination, constipation, abdominal pain, cognitive fog, and in advanced cases, kidney stones or bone pain. Left untreated, it can harm kidneys, heart, and skeleton.

Most Common Causes

Primary hyperparathyroidism (PHPT): Overproduction of PTH (often a single adenoma) → high calcium, low-normal phosphorus, bone loss, kidney stones

Malignancy-related: PTHrP-mediated or osteolytic metastases; tends to be more acute/severe

Vitamin D excess; granulomatous disease (↑ 1,25-OH₂ vitamin D)

Medications: Thiazides, lithium; milk-alkali syndrome from excess calcium/alkali intake

Immobilization in high bone-turnover states; thyrotoxicosis, adrenal insufficiency (less common)

Evaluation

Calcium (total and/or ionized), albumin, PTH

Phosphorus, creatinine/eGFR, 25-OH vitamin D (± 1,25-OH₂), PTHrP when indicated

24-hour urine calcium to distinguish PHPT from FHH (familial hypocalciuric hypercalcemia)

Stone risk work-up if history of nephrolithiasis

If PHPT confirmed and surgery considered: localization imaging (neck U/S, sestamibi, 4D-CT) for operative planning

Management

Acute/severe: IV fluids, calcitonin (short-term), IV bisphosphonate or denosumab for malignancy-related cases

Primary hyperparathyroidism:

Parathyroidectomy is definitive for surgical candidates (symptomatic, stone risk, osteoporosis, very high Ca, reduced kidney function, age <50, etc.)
Non-operative: hydration, moderate calcium intake (not zero), cinacalcet to lower Ca when appropriate, osteoporosis therapy to protect bone

Vitamin D/GI/meds: Correct excesses, treat granulomatous disease; med adjustments as feasible

Bone Context

Chronic hypercalcemia from PHPT accelerates bone turnover and osteoporosis, especially at cortical sites (forearm, hip). We pair calcium control with DXA tracking and, when indicated, bone-active therapy.

CTA: Schedule a hypercalcemia & parathyroid evaluation (Bronxville + telehealth NY).

https://sqmed360.com

Located in Bronxville, serving Westchester & all of New York State.

(914) 292-0300