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Symptoms and Signs – Differential Diagnosis of Hypercalcemia
• Vitamin D intoxication, milk-alkali syndrome: increased GI absorption
• Thiazides: increased renal absorption
• Solid tumors: breast, lung, pancreas, kidneys, ovary
• Parathyroid hyperplasia, adenoma
• Paget’s disease: increased bone resorption, seen only during periods of immobilization
• Other causes: familial hypocalciuric hypercalcemia, thyrotoxicosis, adrenal insufficiency, prolonged immobilization, vitamin A intoxication, recovery from acute renal failure, lithium administration, pheochromocytoma, disseminated systemic lupus erythematosus (SLE)
• Malignant disease: increased bone resorption via osteoclast activating factors, secretion of parathyroid hormone (PTH)–like substances, prostaglandin E2, direct erosion by tumor cells, transforming growth factors, colony-stimulating activity
• Hyperparathyroidism: increased bone resorption, GI absorption, and renal absorption; etiology:
• Hyperparathyroidism or renal failure with secondary hyperparathyroidism
• Hypercalcemia is common in the following neoplasms:
• Hematologic cancers: myeloma, lymphosarcoma, adult T-cell lymphoma, Burkitt’s lymphoma
• Granulomatous disorders: increased GI absorption (e.g., Sarcoidosis)
• Vitamin D intoxication, milk-alkali syndrome: increased GI absorption
• Thiazides: increased renal absorption
• Solid tumors: breast, lung, pancreas, kidneys, ovary
• Parathyroid hyperplasia, adenoma
• Paget’s disease: increased bone resorption, seen only during periods of immobilization
• Other causes: familial hypocalciuric hypercalcemia, thyrotoxicosis, adrenal insufficiency, prolonged immobilization, vitamin A intoxication, recovery from acute renal failure, lithium administration, pheochromocytoma, disseminated systemic lupus erythematosus (SLE)
• Malignant disease: increased bone resorption via osteoclast activating factors, secretion of parathyroid hormone (PTH)–like substances, prostaglandin E2, direct erosion by tumor cells, transforming growth factors, colony-stimulating activity
• Hyperparathyroidism: increased bone resorption, GI absorption, and renal absorption; etiology:
• Hyperparathyroidism or renal failure with secondary hyperparathyroidism
• Hypercalcemia is common in the following neoplasms:
• Hematologic cancers: myeloma, lymphosarcoma, adult T-cell lymphoma, Burkitt’s lymphoma
• Granulomatous disorders: increased GI absorption (e.g., Sarcoidosis)
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