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Abstract

Hypercalcemia is a common medical problem in clinical practice. Many patients are asymptomatic at presentation [1]. Mechanisms of hypercalcemia include increased bone resorption, increased gastrointestinal absorption of calcium and/or increased renal calcium reabsorption. Hypercalcemia can be classified into parathyroid hormone (PTH)-dependent and PTH-independent causes [2]. Primary hyperparathyroidism (PHPT) and malignancy-associated hypercalcemia (MAHC) represent the most common etiologies of hypercalcemia and comprise approximately 80–90 % of the causes of hypercalcemia [3]. In this chapter we will discuss the etiology, clinical manifestations, diagnostic approach, and management of hypercalcemia (Table 9.1).

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References

  1. Yeh MW, Ituarte PH, Zhou HC, Nishimoto S, Liu IL, Harari A, Haigh PI, Adams AL. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab. 2013;98(3):1122–9. Population/Observational Study; Level 3; Grade A-B.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Horwitz MJ, Hodak SP, Stewart AF. Non-parathyroid hypercalcemia. In: Demay M, Jan de Beur SM, editors. Primer on the metabolic bone diseases and disorders of mineral metabolism. 8th ed. Ames, Iowa: American Society of Bone and Mineral Research; 2013. p. 562. Clinical Review; Level 1–3.

    Chapter  Google Scholar 

  3. Lafferty F. Differential diagnosis of hypercalcemia. J Bone Miner Res. 1991;6 Suppl 2:S51–9. Clinical Review; Level 1–3.

    CAS  PubMed  Google Scholar 

  4. Al-Azem H, Khan A. Primary hyperparathyroidism. CMAJ. 2011;183(10):E685–9. Clinical Review; Level 1–3.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Brown E. Mechanism underlying extracellular calcium hemeostasis. In: Khan A, Clark O, editors. Handbook of parathyroid diseases. New York: Springer; 2012. p. 1.

    Chapter  Google Scholar 

  6. Datta N, Abou-Samra B. PTH and PTHrP Signaling in Osteoblasts. Cell Signal. 2009;21(8):1245–54. Basic Science Review; Level 1–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Gardella T. Interactions of PTH with receptors and signaling. In: The parathyroids basic and clinical concepts, 3 ed. San Diego: Academic Press; 2015. Clinical Review; Level 1–3.

    Google Scholar 

  8. Sharretts J, Simonds W. Clinical and molecular genetics of parathyroid neoplasms. Best Pract Res Clin Endocrinol Metab. 2010;24(3):491–502. Basic Science Review; Level 1–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Howson P, Kruijff S, Aniss A, Pennington T, Gill AJ, Dodds T, Delbridge LW, Sidhu SB, Sywak MS. Oxyphil cell parathyroid adenomas causing primary hyperparathyroidism: a clinico-pathological correlation. Endocr Pathol. 2015;26(3):250–4. Clinical Investigation; Level 3; Grade A-B.

    Article  CAS  PubMed  Google Scholar 

  10. Thakker RV, Newey PJ, Walls GV, Bilezikian J, Dralle H, Ebeling PR, Melmed S, Sakurai A, Tonelli F, Brandi ML. Clinical practice guidelines for multiple endocrine neoplasia type 1 (MEN1). J Clin Endocrinol Metab. 2012;97(9):2990–3011. Clinical Review; Level 1–3.

    Article  CAS  PubMed  Google Scholar 

  11. Georgitsi M. MEN-4 and other multiple endocrine neoplasias due to cyclin-dependent kinase inhibitors (p27(Kip1) and p18(INK4C)) mutations. Best Pract Res Clin Endocrinol Metab. 2010;24(3):425–37. Clinical Review; Level 1–3.

    Article  CAS  PubMed  Google Scholar 

  12. Wynne AG, van Heerden J, Carney JA, Fitzpatrick LA. Parathyroid carcinoma: clinical and pathologic features in 43 patients. Medicine (Baltimore). 1992;71(4):197–205. Population/Observational Study; Level 3; Grade A-B.

    Article  CAS  Google Scholar 

  13. Shane E. Clinical review 122: parathyroid carcinoma. J Clin Endocrinol Metab. 2001;86(2):485–93. Population/Observational Study; Level 3; Grade A-B.

    Article  CAS  PubMed  Google Scholar 

  14. Brown EM, Hebert SC. A cloned extracellular Ca(2+)-sensing receptor: molecular mediator of the actions of extracellular Ca2+ on parathyroid and kidney cells? Kidney Int. 1996;49(4):1042–6. Basic Science Review; Level 1–2.

    Article  CAS  PubMed  Google Scholar 

  15. Kos CH, Karaplis AC, Peng JB, Hediger MA, Goltzman D, Mohammad KS, Guise TA, Pollak MR. The calcium-sensing receptor is required for normal calcium homeostasis independent of parathyroid hormone. J Clin Invest. 2003;111(7):1021–8. Clinical Investigation; Level 3; Grade A-B.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Sands JM, Naruse M, Baum M, Jo I, Hebert SC, Brown EM, Harris HW. Apical extracellular calcium/polyvalent cation-sensing receptor regulates vasopressin-elicited water permeability in rat kidney inner medullary collecting duct. J Clin Invest. 1997;99(6):1399–405. Basic Science; Level 1; Grade B.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Goltzman D, Hendy GN. The calcium-sensing receptor in bone--mechanistic and therapeutic insights. Nat Rev Endocrinol. 2015;11(5):298–307. Basic Science Review; Level 1–2.

    Google Scholar 

  18. Arnold A, Marx SJ. Familial primary hyperparathyroidism (Including MEN, FHH, and HPT-JT). In: Demay M, Jan de Beur SM, editors. Primer on the metabolic bone diseases and disorders of mineral metabolism. 8th ed. Ames, Iowa: American Society of Bone and Mineral Research; 2013. p. 553. Clinical Review; Level 1–3.

    Chapter  Google Scholar 

  19. Law Jr WM, Heath 3rd H. Familial benign hypercalcemia (hypocalciuric hypercalcemia). Clinical and pathogenetic studies in 21 families. Ann Intern Med. 1985;102(4):511–9. Population/Observational Study; Level 3; Grade A-B.

    Article  PubMed  Google Scholar 

  20. Christensen SE, Nissen PH, Vestergaard P, Mosekilde L. Familial hypocalciuric hypercalcaemia: a review. Curr Opin Endocrinol Diabetes Obes. 2011;18(6):359–70. Clinical Review; Level 2–3.

    Article  CAS  PubMed  Google Scholar 

  21. Varghese J, Rich T, Jimenez C. Benign familial hypocalciuric hypercalcemia. Endocr Pract. 2011;17 Suppl 1:13–7. Clinical Review; Level 2–3.

    Article  PubMed  Google Scholar 

  22. Rao S, Shoback D. Tertiary hyperparathyroidism pathogenesis, clinical features and medical management. In: Khan A, Clark O, editors. Handbook of parathyroid diseases. New York: Springer; 2012. Clinical Review; Level 2–3.

    Google Scholar 

  23. Drueke T. The pathogenesis of parathyroid gland hyperplasia in chronic renal failure. Kidney Int. 1995;48:259–72. Clinical Review; Level 2–3.

    Article  CAS  PubMed  Google Scholar 

  24. Grzela T, Chudzinski W, Lasiecka Z, Niderla J, Wilczynski G, Gornicka B, Wasiutynski A, Durlik M, Boszczyk A, Brawura-Biskupski-Samaha R, Dziunycz P, Milewski L, Lazarczyk M, Lazarczyk M, Nawrot I. The calcium-sensing receptor and vitamin D receptor expression in tertiary hyperparathyroidism. Int J Mol Med. 2006;17(5):779–83. Clinical Investigation; Level 2–3.

    CAS  PubMed  Google Scholar 

  25. Dewberry LK, Weber C, Sharma J. Near total parathyroidectomy is effective therapy for tertiary hyperparathyroidism. Am Surg. 2014;80(7):646–51. Clinical Investigation; Level 2; Grade A-B.

    PubMed  Google Scholar 

  26. Yoshimoto K, Yamasaki R, Sakai H, Tezuka U, Takahashi M, Iizuka M, Sekiya T, Saito S. Ectopic production of parathyroid hormone by small cell lung cancer in a patient with hypercalcemia. J Clin Endocrinol Metab. 1989;68(5):976–81. Clinical Investigation; Level 4.

    Article  CAS  PubMed  Google Scholar 

  27. Nussbaum SR, Gaz RD, Arnold A. Hypercalcemia and ectopic secretion of parathyroid hormone by an ovarian carcinoma with rearrangement of the gene for parathyroid hormone. N Engl J Med. 1990;323(19):1324–8. Clinical Investigation; Level 4.

    Article  CAS  PubMed  Google Scholar 

  28. Cook MI, Qureshi YA, Todd CE, Cummins RS. An unusual ectopic location of a parathyroid carcinoma arising within the thyroid gland. J Clin Endocrinol Metab. 2012;97(6):1829–33. Clinical Investigation; Level 4.

    Article  CAS  PubMed  Google Scholar 

  29. Zhang SJ, Hu Y, Cao J, Qian HL, Jiao SC, Liu ZF, Tao HT, Han L. Analysis on survival and prognostic factors for cancer patients with malignancy-associated hypercalcemia. Asian Pac J Cancer Prev. 2014;14(11):6715–9. Clinical Investigation; Level 2; Grades A-C.

    Article  PubMed  Google Scholar 

  30. Hamilton F, Carroll R, Hamilton W, Salisbury C. The risk of cancer in primary care patients with hypercalcaemia: a cohort study using electronic records. Br J Cancer. 2014;111(7):1410–2. Clinical Investigation; Level 2; Grade A-C.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Strewler G, Nissenson R. Hypercalcemia in malignancy. West J Med. 1990;153(6):635–40. Clinical Review; Level 2–3.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Strewler G. The physiology of parathyroid hormone-related protein. N Engl J Med. 2000;342(3):177–85. Clinical Review; Level 1–3.

    Article  CAS  PubMed  Google Scholar 

  33. Horwitz M, Tedesco M, Sereika S, Hollis B, Garcia-Ocaña A, Stewart A. Direct comparison of sustained infusion of human parathyroid hormone-related protein-(1–36) [hPTHrP-(1–36)] versus hPTH-(1–34) on serum calcium, plasma 1,25-dihydroxyvitamin D concentrations, and fractional calcium excretion in healthy human volunteers. J Clin Endocrinol Metab. 2003;88(4):1603–9. Population/Observational Study; Level 3; Grade A.

    Article  CAS  PubMed  Google Scholar 

  34. Dean T, Vilardaga JP, Potts Jr JT, Gardella TJ. Altered selectivity of parathyroid hormone (PTH) and PTH-related protein (PTHrP) for distinct conformations of the PTH/PTHrP receptor. Mol Endocrinol. 2008;22(1):156–66. Basic Science; Level 2; Grade B-C.

    Article  CAS  PubMed  Google Scholar 

  35. Murray TM, Rao LG, Divieti P, Bringhurst FR. Parathyroid hormone secretion and action: evidence for discrete receptors for the carboxyl-terminal region and related biological actions of carboxyl- terminal ligands. Endocr Rev. 2005;26(1):78–113. Basic Science; Level 2; Grade B-C.

    Article  CAS  PubMed  Google Scholar 

  36. Dagdelen S, Kalan I, Gurlek A. Humoral hypercalcemia of benignancy secondary to parathyroid hormone-related protein secreting uterine leiomyoma. Am J Med Sci. 2008;335(5):407–8. Clinical Investigation; Level 4.

    Article  PubMed  Google Scholar 

  37. Kimura S, Nishimura Y, Yamaguchi K, Nagasaki K, Shimada K, Uchida H. A case of pheochromocytoma producing parathyroid hormone-related protein and presenting with hypercalcemia. J Clin Endocrinol Metab. 1990;70(6):1559–63. Clinical Investigation; Level 4.

    Article  CAS  PubMed  Google Scholar 

  38. Philbrick WM, Wysolmerski JJ, Galbraith S, Holt E, Orloff JJ, Yang KH, Vasavada RC, Weir EC, Broadus AE, Stewart AF. Defining the roles of parathyroid hormone-related protein in normal physiology. Physiol Rev. 1996;76(1):127–73. Clinical Review; Level 1–3.

    CAS  PubMed  Google Scholar 

  39. Guise TA, Yin JJ, Taylor SD, Kumagai Y, Dallas M, Boyce BF, Yoneda T, Mundy GR. Evidence for a causal role of parathyroid hormone-related protein in the pathogenesis of human breast cancer-mediated osteolysis. J Clin Invest. 1996;98(7):1544–9. Clinical Investigation; Level 4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Grill V, Ho P, Body JJ, Johanson N, Lee SC, Kukreja SC, Moseley JM, Martin TJ. Parathyroid hormone-related protein: elevated levels in both humoral hypercalcemia of malignancy and hypercalcemia complicating metastatic breast cancer. J Clin Endocrinol Metab. 1991;73(6):1309–15. Clinical Investigation; Level 4.

    Article  CAS  PubMed  Google Scholar 

  41. Roodman GD. Pathogenesis of myeloma bone disease. J Cell Biochem. 2010;109(2):283–91. Clinical Review; Level 1–2.

    CAS  PubMed  Google Scholar 

  42. Oyajobi BO, Mundy GR. Receptor activator of NF-kappaB ligand, macrophage inflammatory protein-1alpha, and the proteasome: novel therapeutic targets in myeloma. Cancer. 2003;97(3 Suppl):813–7. Basic Science Review; Level 1–2.

    Article  PubMed  Google Scholar 

  43. Yang Y, Ren Y, Ramani VC, Nan L, Suva LJ, Sanderson RD. Heparanase enhances local and systemic osteolysis in multiple myeloma by upregulating the expression and secretion of RANKL. Cancer Res. 2010;70(21):8329–38. Basic Science; Level 1–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Roodman GD. Mechanisms of bone lesions in multiple myeloma and lymphoma. Cancer. 1997;80(8 Suppl):1557–63. Basic Science Review; Level 1–2.

    Article  CAS  PubMed  Google Scholar 

  45. Lakatos P, Foldes J, Horvath C, Kiss L, Tatrai A, Takacs I, Tarjan G, Stern PH. Serum interleukin-6 and bone metabolism in patients with thyroid function disorders. J Clin Endocrinol Metab. 1997;82(1):78–81. Clinical Investigation; Level 2–3.

    CAS  PubMed  Google Scholar 

  46. Burman KD, Monchik JM, Earll JM, Wartofsky L. Ionized and total serum calcium and parathyroid hormone in hyperthyroidism. Ann Intern Med. 1976;84(6):668–71.

    Article  CAS  PubMed  Google Scholar 

  47. Iqbal AA, Burgess EH, Gallina DL, Nanes MS, Cook CB. Hypercalcemia in hyperthyroidism: patterns of serum calcium, parathyroid hormone, and 1,25-dihydroxyvitamin D3 levels during management of thyrotoxicosis. Endocr Pract. 2003;9(6):517–21. Population/Observational Study; Level 3; Grade A.

    Article  PubMed  Google Scholar 

  48. Baxi SC, Dailey 3rd GE. Hypervitaminosis A. A cause of hypercalcemia. West J Med. 1982;137(5):429–31. Clinical Investigation; Level 4.

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Akiyama H, Nakamura N, Nagasaka S, Sakamaki H, Onozawa Y. Hypercalcaemia due to all-trans retinoic acid. Lancet. 1992;339(8788):308–9. Clinical Investigation; Level 4.

    Article  CAS  PubMed  Google Scholar 

  50. Stewart AF, Adler M, Byers CM, Segre GV, Broadus AE. Calcium homeostasis in immobilization: an example of resorptive hypercalciuria. N Engl J Med. 1982;306(19):1136–40. Clinical Investigation; Level 4.

    Article  CAS  PubMed  Google Scholar 

  51. Hyman LR, Boner G, Thomas JC, Segar WE. Immobilization hypercalcemia. Am J Dis Child. 1972;124(5):723–7. Clinical Investigation; Level 4.

    CAS  PubMed  Google Scholar 

  52. Gallacher SJ, Ralston SH, Dryburgh FJ, Logue FC, Allam BF, Boyce BF, Boyle IT. Immobilization-related hypercalcaemia--a possible novel mechanism and response to pamidronate. Postgrad Med J. 1990;66(781):918–22. Clinical Investigation; Level 4.

    Google Scholar 

  53. Malberti F. Treatment of immobilization-related hypercalcaemia with denosumab. Clin Kidney J. 2012;5(6):491–5. Clinical Investigation; Level 4.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Seymour JF, Gagel RF. Calcitriol: the major humoral mediator of hypercalcemia in Hodgkin’s disease and non-Hodgkin’s lymphomas. Blood. 1993;82(5):1383–94. Clinical Review; Level 2; Grade B-C.

    Google Scholar 

  55. Hibi M, Hara F, Tomishige H, Nishida Y, Kato T, Okumura N, Hashimoto T, Kato R. 1,25-dihydroxyvitamin D-mediated hypercalcemia in ovarian dysgerminoma. Pediatr Hematol Oncol. 2008;25(1):73–8. Clinical Investigation; Level 4.

    Article  PubMed  Google Scholar 

  56. Barbour GL, Coburn JW, Slatopolsky E, Norman AW, Horst RL. Hypercalcemia in an anephric patient with sarcoidosis: evidence for extrarenal generation of 1,25-dihydroxyvitamin D. N Engl J Med. 1981;305(8):440–3. Clinical Investigation; Level 4.

    Article  CAS  PubMed  Google Scholar 

  57. Sharma OP. Hypercalcemia in granulomatous disorders: a clinical review. Curr Opin Pulm Med. 2000;6(5):442–7. Clinical Review; Level 2; Grade C.

    Article  CAS  PubMed  Google Scholar 

  58. Chan TY. Differences in vitamin D status and calcium intake: possible explanations for the regional variations in the prevalence of hypercalcemia in tuberculosis. Calcif Tissue Int. 1997;60(1):91–3. Population/Observational Study; Level 3; Grade B-C.

    Article  CAS  PubMed  Google Scholar 

  59. Tercelj M, Rott T, Rylander R. Antifungal treatment in sarcoidosis--a pilot intervention trial. Respir Med. 2007;101(4):774–8. Clinical Investigation; Level 2; Grade B.

    Google Scholar 

  60. Hoeck HC, Laurberg G, Laurberg P. Hypercalcaemic crisis after excessive topical use of a vitamin D derivative. J Intern Med. 1994;235(3):281–2. Clinical Investigation; Level 4.

    Article  CAS  PubMed  Google Scholar 

  61. Vogiatzi MG, Jacobson-Dickman E, DeBoer MD. Vitamin D supplementation and risk of toxicity in pediatrics: a review of current literature. J Clin Endocrinol Metab. 2014;99(4):1132–41. Clinical Review; Level 2–3.

    Article  CAS  PubMed  Google Scholar 

  62. Holick MF, MacLaughlin JA, Doppelt SH. Regulation of cutaneous previtamin D3 photosynthesis in man: skin pigment is not an essential regulator. Science. 1981;211(4482):590–3. Clinical Review; Level 2–3.

    Article  CAS  PubMed  Google Scholar 

  63. Selby PL, Davies M, Marks JS, Mawer EB. Vitamin D intoxication causes hypercalcaemia by increased bone resorption which responds to pamidronate. Clin Endocrinol (Oxf). 1995;43(5):531–6. Clinical Review; Level 2–3.

    Article  CAS  Google Scholar 

  64. Arroyo M, Fenves AZ, Emmett M. The calcium-alkali syndrome. Proc (Bayl Univ Med Cent). 2013;26(2):179–81. Clinical Review; Level 2–3.

    Google Scholar 

  65. Riccardi D, Brown EM. Physiology and pathophysiology of the calcium-sensing receptor in the kidney. Am J Physiol Renal Physiol. 2010;298(3):F485–99.

    Article  CAS  PubMed  Google Scholar 

  66. Felsenfeld AJ, Levine BS. Milk alkali syndrome and the dynamics of calcium homeostasis. Clin J Am Soc Nephrol. 2006;1(4):641–54. Clinical Review; Level 2–3.

    Article  CAS  PubMed  Google Scholar 

  67. Shike M, Harrison JE, Sturtridge WC, Tam CS, Bobechko PE, Jones G, Murray TM, Jeejeebhoy KN. Metabolic bone disease in patients receiving long-term total parenteral nutrition. Ann Intern Med. 1980;92(3):343–50. Clinical Investigation; Level 3; Grade A-B.

    Article  CAS  PubMed  Google Scholar 

  68. de Vernejoul MC, Messing B, Modrowski D, Bielakoff J, Buisine A, Miravet L. Multifactorial low remodeling bone disease during cyclic total parenteral nutrition. J Clin Endocrinol Metab. 1985;60(1):109–13. Clinical Investigation; Level 3; Grade C.

    Article  PubMed  Google Scholar 

  69. Ott SM, Maloney NA, Klein GL, Alfrey AC, Ament ME, Coburn JW, Sherrard DJ. Aluminum is associated with low bone formation in patients receiving chronic parenteral nutrition. Ann Intern Med. 1983;98(6):910–4. Clinical Review; Level 3; Grade B.

    Article  CAS  PubMed  Google Scholar 

  70. Grieff M, Bushinsky DA. Diuretics and disorders of calcium homeostasis. Semin Nephrol. 2011;31(6):535–41. Clinical Review; Level 2; Grade C.

    Article  CAS  PubMed  Google Scholar 

  71. Wermers RA, Kearns AE, Jenkins GD, Melton 3rd LJ. Incidence and clinical spectrum of thiazide-associated hypercalcemia. Am J Med. 2007;120(10):911. Clinical Review; Level 2–3.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Lehmann SW, Lee J. Lithium-associated hypercalcemia and hyperparathyroidism in the elderly: what do we know? J Affect Disord. 2013;146(2):151–7. Clinical Review; Level 2–3.

    Article  CAS  PubMed  Google Scholar 

  73. Albert U, De Cori D, Aguglia A, Barbaro F, Lanfranco F, Bogetto F, Maina G. Lithium-associated hyperparathyroidism and hypercalcaemia: a case–control cross-sectional study. J Affect Disord. 2013;151(2):786–90. Clinical Investigation; Level 3; Grade A-B.

    Article  CAS  PubMed  Google Scholar 

  74. Waller DG, Albano JD, Millar JG, Polak A. Impairment of cyclic AMP response to bovine parathyroid hormone in patients on chronic lithium therapy with diminished renal urine-concentrating ability. Clin Sci (Lond). 1983;64(6):623–7. Clinical Investigation; Level 2; Grade C.

    Article  CAS  Google Scholar 

  75. Sloand JA, Shelly MA. Normalization of lithium-induced hypercalcemia and hyperparathyroidism with cinacalcet hydrochloride. Am J Kidney Dis. 2006;48(5):832–7. Clinical Investigation; Level 4.

    Article  PubMed  Google Scholar 

  76. Norlén O, Sidhu S, Sywak M, Delbridge L. Long-term outcome after parathyroidectomy for lithium-induced hyperparathyroidism. Br J Surg. 2014;101(10):1252–6. Population/Observational Study; Level 3; Grade A.

    Article  PubMed  Google Scholar 

  77. McPherson ML, Prince SR, Atamer ER, Maxwell DB, Ross-Clunis H, Estep HL. Theophylline-induced hypercalcemia. Ann Intern Med. 1986;105(1):52–4. Clinical Investigation; Level 4.

    Article  CAS  PubMed  Google Scholar 

  78. Hodsman AB, Bauer DC, Dempster DW, Dian L, Hanley DA, Harris ST, Kendler DL, McClung MR, Miller PD, Olszynski WP, Orwoll E, Yuen CK. Parathyroid hormone and teriparatide for the treatment of osteoporosis: a review of the evidence and suggested guidelines for its use. Endocr Rev. 2005;26(5):688–703. Clinical Review; Level 2–3.

    Article  CAS  PubMed  Google Scholar 

  79. Muls E, Bouillon R, Boelaert J, Lamberigts G, Van Imschoot S, Daneels R, De Moor P. Etiology of hypercalcemia in a patient with Addison’s disease. Calcif Tissue Int. 1982;34(6):523. Clinical Investigation; Level 4.

    Google Scholar 

  80. Bridgewater JA, Ratcliffe WA, Bundred NJ, Owens CW. Malignant phaeochromocytoma and hypercalcaemia. Postgrad Med J. 1993;69(807):77.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  81. Akmal M, Bishop JE, Telfer N, Norman AW, Massry SG. Hypocalcemia and hypercalcemia in patients with rhabdomyolysis with and without acute renal failure. J Clin Endocrinol Metab. 1986;63(1):137. Clinical Investigation; Level 4.

    Article  CAS  PubMed  Google Scholar 

  82. Schipani E, Langman CB, Parfitt AM, Jensen GS, Kikuchi S, Kooh SW, Cole WG, Jüppner H. Constitutively activated receptors for parathyroid hormone and parathyroid hormone-related peptide in Jansen’s metaphyseal chondrodysplasia. N Engl J Med. 1996;335(10):708. Clinical Investigation; Level 4.

    Google Scholar 

  83. Saarela T, Similä S, Koivisto M. Hypercalcemia and nephrocalcinosis in patients with congenital lactase deficiency. J Pediatr. 1995;127(6):920–3. Clinical Investigation; Level 4.

    Article  CAS  PubMed  Google Scholar 

  84. Lameris AL, Geesing CL, Hoenderop JG, Schreuder MF. Importance of dietary calcium and vitamin D in the treatment of hypercalcaemia in Williams-Beuren syndrome. J Pediatr Endocrinol Metab. 2014;27(7–8):757–61. doi:10.1515/jpem-2013-0229. Clinical Investigation; Level 4.

    CAS  PubMed  Google Scholar 

  85. Inzucchi SE. Understanding hypercalcemia. Its metabolic basis, signs, and symptoms. Postgrad Med. 2004;115(4):69–70. 73–6. Clinical Review; Level 2–3.

    Article  PubMed  Google Scholar 

  86. Pearce CJ, Hine TJ, Peek K. Hypercalcaemia due to calcium binding by a polymeric IgA kappa-paraprotein. Ann Clin Biochem. 1991;28(Pt 3):229–34. Clinical Investigation; Level 4.

    Article  PubMed  Google Scholar 

  87. Payne RB, Little AJ, Williams RB, Milner JR. Interpretation of serum calcium in patients with abnormal serum proteins. Br Med J. 1973;4(5893):643–6. Clinical Review; Level 1–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  88. Glendenning P, Gutteridge DH, Retallack RW, Stuckey BG, Kermode DG, Kent GN. High prevalence of normal total calcium and intact PTH in 60 patients with proven primary hyperparathyroidism: a challenge to current diagnostic criteria. Aust N Z J Med. 1998;28(2):173–8. Population/Observational Study; Level 2; Grade A.

    CAS  PubMed  Google Scholar 

  89. Bilezikian JP. Approach to parathyroid disorders. In: Demay M, Jan de Beur SM, editors. Primer on the metabolic bone diseases and disorders of mineral metabolism. 8th ed. Ames, Iowa: American Society of Bone and Mineral Research; 2013. p. 537. Clinical Review; Level 1–2.

    Google Scholar 

  90. Reagan P, Pani A, Rosner MH. Approach to diagnosis and treatment of hypercalcemia in a patient with malignancy. Am J Kidney Dis. 2014;63(1):141–7. Clinical Review; Level 1–2.

    Article  PubMed  Google Scholar 

  91. Tee MC, Holmes DT, Wiseman SM. Ionized vs serum calcium in the diagnosis and management of primary hyperparathyroidism: which is superior? Am J Surg. 2013;205(5):591–6. Clinical Investigation; Level 3; Grade A-B.

    Article  CAS  PubMed  Google Scholar 

  92. Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, Potts Jr JT. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the fourth international workshop. J Clin Endocrinol Metab. 2014;99(10):3561–9. Clinical Review; Level 1–2.

    Article  CAS  PubMed  Google Scholar 

  93. Bilezikian JP. Clinical review 51: management of hypercalcemia. J Clin Endocrinol Metab. 1993;77(6):1445–9. Clinical Review; Level 1–2.

    CAS  PubMed  Google Scholar 

  94. Pallan S, Rahman MO, Khan AA. Diagnosis and management of primary hyperparathyroidism. BMJ. 2012;344:e1013. Clinical Review; Level 1–2.

    Article  PubMed  Google Scholar 

  95. Khan A, Bilezikian J, Bone H, Gurevich A, Lakatos P, Misiorowski W, Rozhinskaya L, Trotman ML, Tóth M. Cinacalcet normalizes serum calcium in a double-blind randomized, placebo-controlled study in patients with primary hyperparathyroidism with contraindications to surgery. Eur J Endocrinol. 2015;172(5):527–35. Epub 2015 Jan 30. Clinical Investigation; Level 1; Grade B.

    Article  CAS  PubMed  Google Scholar 

  96. Khan AA, Bilezikian JP, Kung AW, Ahmed MM, Dubois SJ, Ho A, Schussheim D, Rubin M, Shaikh A, Silverberg SJ, Standish T, Syed Z, Syed ZA. Alendronate in primary hyperparathyroidism: a double-blind, randomized, placebo-controlled trial. J Clin Endocrinol Metab. 2004;89:3319–25. Clinical Investigation; Level 1; Grade B.

    Article  CAS  PubMed  Google Scholar 

  97. Overman RA, Borse M, Gourlay ML. Salmon calcitonin use and associated cancer risk. Ann Pharmacother. 2013;47(12):1675–84. Clinical Investigation; Level 2; Grade C.

    Article  CAS  PubMed  Google Scholar 

  98. Maier JD, Levine SN. Hypercalcemia in the intensive care unit: a review of pathophysiology, diagnosis, and modern therapy. J Intensive Care Med. 2015;30(5):235–52. Clinical Review; Level 2–3.

    Article  PubMed  Google Scholar 

  99. Major P, Lortholary A, Hon J, Abdi E, Mills G, Menssen HD, Yunus F, Bell R, Body J, Quebe-Fehling E, Seaman J. Zoledronic acid is superior to pamidronate in the treatment of hypercalcemia of malignancy: a pooled analysis of two randomized, controlled clinical trials. J Clin Oncol. 2001;19(2):558–67. Clinical Review; Level 1; Grade A.

    CAS  PubMed  Google Scholar 

  100. Pecherstorfer M, Herrmann Z, Body JJ, Manegold C, Degardin M, Clemens MR, Thürlimann B, Tubiana-Hulin M, Steinhauer EU, van Eijkeren M, Huss HJ, Thiébaud D. Randomized phase II trial comparing different doses of the bisphosphonate ibandronate in the treatment of hypercalcemia of malignancy. J Clin Oncol. 1996;14(1):268–76. Clinical Investigation; Level 1; Grade B.

    CAS  PubMed  Google Scholar 

  101. Adhikaree J, Newby Y, Sundar S. Denosumab should be the treatment of choice for bisphosphonate refractory hypercalcaemia of malignancy. BMJ Case Rep. 2014;2014. Clinical Investigation; Level 4.

    Google Scholar 

  102. Hu MI, Glezerman IG, Leboulleux S, Insogna K, Gucalp R, Misiorowski W, Yu B, Zorsky P, Tosi D, Bessudo A, Jaccard A, Tonini G, Ying W, Braun A, Jain RK. Denosumab for treatment of hypercalcemia of malignancy. J Clin Endocrinol Metab. 2014;99(9):3144–52. Clinical Investigation; Level 2; Grade B.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  103. Cicci JD, Buie L, Bates J, van Deventer H. Denosumab for the management of hypercalcemia of malignancy in patients with multiple myeloma and renal dysfunction. Clin Lymphoma Myeloma Leuk. 2014;14(6):e207–11. Clinical Investigation; Level 2–3.

    Article  PubMed  Google Scholar 

  104. Cardella CJ, Birkin BL, Rapoport A. Role of dialysis in the treatment of severe hypercalcemia: report of two cases successfully treated with hemodialysis and review of the literature. Clin Nephrol. 1979;12(6):285–90. Clinical Investigation; Level 4.

    CAS  PubMed  Google Scholar 

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Hashem, W.A., Orr, C.J., Khan, A.A. (2017). Hypercalcemia. In: Stack, Jr., B., Bodenner, D. (eds) Medical and Surgical Treatment of Parathyroid Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-26794-4_9

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