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Introduction
  • An increase in serum calcium level
  • Mechanisms and pathophysiology
    • dietary causes
      • calcium ingestion (milk-alkali syndrome)
      • hypervitaminosis D
      • hypervitaminosis A
    • pharmacologic causes
      • thiazides
        • causes increased tubular reabsorption of calcium
        • used to treat hypercalciuria
    • malignancy-associated causes
      • Paget's disease
        • typically does not result in hypercalcemia
        • can be come hypercalcemic if patient is immobilized
      • squamous cell cancer of the lung
        • ectopic production of PTH (PTH related peptide - PTHrP)
      • multiple myeloma
        • production of IL-1 activates osteoclast-driven bone resporption
    • sarcoidosis
      • granulomatous macrophages produce 1α-hydroxylase which produces high amounts of 1,25 vitamin D
    • hyperparathyroid 
    • genetic causes
      • familial hypocalciuric hypercalcemia
        • defect in calcium sensor of parathyroid gland
          • there is a loss of negative feedback on PTH by hypercalcemia
          • PTH levels are normal to high despite high serum calcium levels
        • urine excretion of calcium is low
          • key feature distinguishing primary hyperparathyroidism from FHH
    • other causes
      • hyperthyroid
      • Addison's disease
      • Zollinger-Ellison syndrome
Presentation
  • Symptoms
    • CNS
      • confusion
      • stupor
      • weakness
    • gastrointestinal
      • constipation
      • anorexia
      • nausea
      • vomiting
    • kidney
      • polyuria
      • kidney stones
      • polydipsia
  • Physical exam
    • weakness
Treatment
  • Conservative
    • hydration
      • saline diuresis
  • Pharmacologic
    • loop diuretics
    • bisphosphonates
    • mithramycin
    • calcitonin
    • galium nitrate
  • Other
    • dialysis
 

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