Hypercalcemia syndrome: diagnostic search and approaches to therapy

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Hypercalcemia syndrome (HC) is a calcium-phosphorus metabolism disorder that often taking place in clinical practice. Literature review presents current data on the main aspects of calcium homeostasis, the level of which is strictly supervised by hormonal control; the role and mechanisms of calcium-regulating hormones action are also considered, and various causes of HC are highlighted. Article describes the clinical picture of hypercalcemia syndrome and approaches to differential diagnostics in various clinical situations. Particular attention is paid to the symptoms, diagnostics and modern methods of treatment of primary hyperparathyroidism – the one of the leading causes of HC development.

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作者简介

Elena Biryukova

Russian University of Medicine of the Ministry of Healthcare of Russia; A.S. Loginov Moscow Clinical Research Center of the Department of Healthcare of Moscow

编辑信件的主要联系方式.
Email: lena@obsudim.ru
ORCID iD: 0000-0001-9007-4123
SPIN 代码: 3700-9150

MD, Dr. Sci. (Medicine), professor of the Department of endocrinology and diabetology

俄罗斯联邦, Moscow; Moscow

Mikhail Shinkin

A.S. Loginov Moscow Clinical Research Center of the Department of Healthcare of Moscow

Email: m.shinkin@mknc.ru
ORCID iD: 0000-0003-1548-1487
SPIN 代码: 2684-1579

MD, researcher at the Department of endocrine and metabolic diseases, endocrinologist

俄罗斯联邦, Moscow

Ashot Mkrtumyan

Russian University of Medicine of the Ministry of Healthcare of Russia; A.S. Loginov Moscow Clinical Research Center of the Department of Healthcare of Moscow

Email: vagrashot@mail.ru
ORCID iD: 0000-0003-1316-5245
SPIN 代码: 1980-8700

MD, Dr. Sci. (Medicine), professor, head of the Department of endocrinology and diabetology, head of the Department of endocrine and metabolic diseases

俄罗斯联邦, Moscow; Moscow

Irina Morozova

A.S. Loginov Moscow Clinical Research Center of the Department of Healthcare of Moscow

Email: i.morozova@mknc.ru
ORCID iD: 0000-0002-1939-261X
SPIN 代码: 3272-3387

MD, PhD (Medicine), senior researcher at the Department of endocrine and metabolic diseases

俄罗斯联邦, Moscow

参考

  1. Flowers KC, Shipman KE, Shipman AR, Gitoees NLJ. Investigative algorithms for disorders causing hypercalcaemia and hypocalcaemia: A narrative review. J Lab Precis Med. 2024;9:27. https://dx.doi.org/10.21037
  2. Renaghan ADM, Rosner M. Hypercalcemia: Etiology and management. Nephrol Dial Transpl. 2018;33(4):549–51. https://doi.org/10.1093/ndt/gfy054
  3. Мокрышева Н.Г., Еремкина А.К., Мирная С.С., Крупинова Ю.А., Воронкова И.А., Ким И.В. с соавт. Клинические рекомендации по первичному гиперпаратиреозу, краткая версия. Проблемы эндокринологии. 2021;67(4):94–124. [Mokrysheva NG, Eremkina AK, Mirnaya SS, Krupinova YuA, Voronkova IA, Kim IV et al. The clinical practice guidelines for primary hyperparathyroidism, short version. Problemy endokrinologii = Problems of Endocrinology. 2021;67(4):94–124 (In Russ.)]. EDN: GKEEJB. https://doi.org/10.14341/probl12801
  4. Terrell K, Choi S, Choi S. Calcium’s role and signaling in aging muscle, cellular senescence, and mineral interactions. Int J Mol Sci. 2023;24(23):17034. PMID: 38069357. PMCID: PMC10706910. https://doi.org/10.3390/ijms242317034
  5. Thillainadesan S, Twigg SM, Perera N. Prevalence, causes and associated mortality of hypercalcaemia in modern hospital care. Intern Med J. 2022;52(9):1596–1601. PMID: 34092015. https://doi.org/10.1111/imj.15402
  6. Venyo AK-G, Adaramod O. Hypercalcemia: A review and update. J Urol Neph St. 2023;4(1):397–422. https://doi.org/10.32474/JUNS.2023.04.000179
  7. Воронцова М.В., Кулебякин К.Ю., Маказан Н.В., Созаева Л.С., Тюрин-Кузьмин П.А. Паратиреоидный гормон в регуляции процессов роста и резорбции кости в норме и патологии. Вестник Российской академии медицинских наук. 2021;76(5):506–517. [Vorontsova MV, Kulebyakin KYu, Makazan NV, Sozaeva LS, Tyurin-Kuzmin PA. Parathyroid hormone in the regulation of bone growth and resorption in health and disease. Vestnik Rossiyskoy akademii meditsinskikh nauk = Annals of the Russian Academy of Medical Sciences. 2021;76(5):506–517 (In Russ.)]. EDN: EJLRBV. https://doi.org/https://doi.org/10.15690/vramn1440
  8. Martin TJ. PTH1R actions on bone using the cAMP/protein kinase a pathway. Front Endocrinol (Lausanne). 2022;12:833221. PMID: 35126319. PMCID: PMC8807523. https://doi.org/10.3389/fendo.2021.833221
  9. Matikainen N, Pekkarinen T, Ryhänen EM, Schalin-Jäntti C. Physiology of calcium homeostasis: An overview. Endocrinol Metab Clin North Am. 2021;50(4):575–90. PMID: 34774235. https://doi.org/10.1016/j.ecl.2021.07.005
  10. Kuzma M, Jackuliak P, Killinger Z, Payer J. Parathyroid hormone-related changes of bone structure. Physiol Res. 2021;70(Suppl 1):S3–S11. PMID: 34918524. PMCID: PMC8884379. https://doi.org/10.33549/physiolres.934779
  11. Мокрышева Н.Г., Крупинова Ю.А., Ковалева Е.В. Паратиреоидный гормон и подобные ему пептиды. Обзор литературы. Вестник Российской академии медицинских наук. 2019;74(2):136–144. [Mokrysheva NG, Krupinova YuA, Kovaleva EV. The parathyroid hormone and peptides like it. Literature review. Vestnik Rossiyskoy akademii meditsinskikh nauk = Annals of the Russian Academy of Medical Sciences. 2019;74(2):136–144 (In Russ.)]. EDN: EFXNKA. https://doi.org/10.15690/vramn1104
  12. Gianella F, Hsia CC, Sakhaee K. The role of vitamin D in sarcoidosis. Fac Rev. 2020;9:14. PMID: 33659946. PMCID: PMC7886067. https://doi.org/10.12703/b/9-14
  13. Goltzman D, Mannstadt M, Marcocci C. Physiology of the calcium-parathyroid hormone-vitamin D axis. Front Horm Res. 2018;50:1–13. PMID: 29597231. https://doi.org/10.1159/000486060
  14. Walker MD, Silverberg SJ. Primary hyperparathyroidism. Nat Rev Endocrinol. 2018;14(2):115–25. PMID: 28885621. PMCID: PMC6037987. https://doi.org/10.1038/nrendo.2017.104
  15. Fleet JS. The role of vitamin D in the endocrinology controlling calcium homeostasis. Mol Cell Endocrinol. 2017;453:36–45. PMID: 28400273. PMCID: PMC5529228. https://doi.org/10.1016/j.mce.2017.04.008
  16. Агранович Н.В., Пилипович Л.А., Алботова Л.В., Классова А.Т. К вопросу о дефиците витамина D при хронической болезни почек. Литературный обзор. Нефрология. 2019;23(3):21–28. [Agranovich NV, Pilipovich LA, Albotova LV, Klassova AT. About the question of vitamin D deficiency in chronic kidney disease. Literature review. Nefrologiya = Nephrology (Saint Petersburg). 2019;23(3):21–28 (In Russ.)]. EDN: ZEOOGQ. https://doi.org/10.24884/1561-6274-2019-23-3-21-28
  17. Bikle D, Christakos S. New aspects of vitamin D metabolism and action – addressing the skin as source and target. Nat Rev Endocrinol. 2020;16(4):234–52. PMID: 32029884. https://doi.org/10.1038/s41574-019-0312-5
  18. Pike JW, Christakos S. Biology and mechanisms of action of the vitamin D hormone. Endocrinol Metab Clin North Am. 2017;46(4):815–43. PMID: 29080638. PMCID: PMC5762112. https://doi.org/10.1016/j.ecl.2017.07.001
  19. Khammissa RAG, Fourie J, Motswaledi MH, Ballyram R, Lemmer J, Feller L. The biological activities of vitamin D and its receptor in relation to calcium and bone homeostasis, cancer, immune and cardiovascular systems, skin biology, and oral health. Biomed Res Int. 2018;2018:9276380. PMID: 29951549. PMCID: PMC5987305. https://doi.org/10.1155/2018/9276380
  20. Felsenfeld AJ, Levine BS. Calcitonin, the forgotten hormone: Does it deserve to be forgotten? Clin Kidney J. 2015;8(2):180–87. PMID: 25815174. PMCID: PMC4370311. https://doi.org/10.1093/ckj/sfv011
  21. Goldner W. Cancer-related hypercalcemia. J Oncol Pract. 2016;12(5):426–32. PMID: 27170690. https://doi.org/10.1200/jop.2016.011155
  22. Bollerslev J, Pretorius M, Heck A. Parathyroid hormone independent hypercalcemia in adults. Best Pract Res Clin Endocrinol Metab. 2018;32(5):621–38. PMID: 30449545. https://doi.org/10.1016/j.beem.2018.06.005
  23. Bilezikian JP, Bandeira L, Khan A, Cusano NE. Hyperparathyroidism. Lancet Lond Engl. 2018;391(10116):168–78. PMID: 28923463. https://doi.org/10.1016/S0140-6736(17)31430-7
  24. Крупинова Ю.А., Алмасханова А.А., Еремкина А.К., Бибик Е.Е., Васильев Е.В., Мокрышева Н.Г. Серия клинических случаев синдрома семейной гипокальциурической гиперкальциемии. Проблемы эндокринологии. 2020;66(5):61–69. [Krupinova YuA, Almaskhanova AA, Eremkina AK, Bibik EE, Vasilyev EV, Mokrysheva NG. A series of clinical cases of familial hypocalciuric hypercalcemia syndrome. Problemy endokrinologii = Problems of Endocrinology. 2020;66(5):61–69 (In Russ.)]. EDN: ODBBSK. https://doi.org/10.14341/probl12537
  25. Fuleihan GE-H, Clines GA, Hu MI, Marcocci C, Murad MH, Piggott T et al. Treatment of hypercalcemia of malignancy in adults: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2023;108(3):507–28. PMID: 36545746. https://doi.org/10.1210/clinem/dgac621
  26. Guise TA, Wysolmerski JJ. Cancer-associated hypercalcemia. N Engl J Med. 2022;386(15):1443–51. PMID: 35417639. https://doi.org/10.1056/nejmcp2113128
  27. Almuradova E, Cicin I. Cancer-related hypercalcemia and potential treatments. Front Endocrinol (Lausanne). 2023;14:1039490. PMID: 37033238. PMCID: PMC10073684. https://doi.org/10.3389/fendo.2023.1039490
  28. Truong NU, deB Edwardes MD, Papavasiliou V, Goltzman D, Kremer R. Parathyroid hormone-related peptide and survival of patients with cancer and hypercalcemia. Am J Med. 2003;115(2):115–21. PMID: 12893397. https://doi.org/10.1016/s0002-9343(03)00310-3
  29. Zagzag J, Hu MI, Fisher SB, Perrier ND. Hypercalcemia and cancer: Differential diagnosis and treatment. CA Cancer J Clin. 2018;68(5):377–86. PMID: 30240520. https://doi.org/10.3322/caac.21489
  30. Sternlicht H, Glezerman IG. Hypercalcemia of malignancy and new treatment options. Ther Clin Risk Manag. 2015;11:1779–88. PMID: 26675713. PMCID: PMC4675637. https://doi.org/10.2147/TCRM.S83681
  31. Shi S, Zhang L, Yu Y, Wang C, Li J. Acromegaly and non-parathyroid hormone-dependent hypercalcemia: A case report and literature review. BMC Endocr Disord. 2021;21(1):90. PMID: 33933067. PMCID: PMC8088721. https://doi.org/10.1186/s12902-021-00756-z
  32. Kaur K, Batra N, Kadian K, Sridharan K. Hypercalcaemia as the initial presentation of Graves’ disease. BMJ Case Rep. 2022;15(8):e251454. PMID: 35985738. PMCID: PMC9396191. https://doi.org/10.1136/bcr-2022-251454
  33. Turner J, Haider A, Barghouthi N, Symczyk O. PTH-independent hypercalcemia in undiagnosed adrenal insufficiency. Journal of the Endocrine Society. 2021;5(Supplement_1):A154–A155. https://doi.org/10.1210/jendso/bvab048.312
  34. Taylor PN, Davies JS. A review of the growing risk of vitamin D toxicity from inappropriate practice. Br J Clin Pharmacol. 2018;84(6):1121–27. PMID: 29498758. PMCID: PMC5980613. https://doi.org/10.1111/bcp.13573
  35. Lim K, Thadhani R. Vitamin D toxicity. J Bras Nefrol. 2020;42(2):238–44. PMID: 32255467. PMCID: PMC7427646. https://doi.org/10.1590/2175-8239-jbn-2019-0192
  36. Minisola S, Pepe J, Piemonte S, Cipriani C. The diagnosis and management of hypercalcaemia. BMJ. 2015;350:h2723. PMID: 26037642. https://doi.org/10.1136/bmj.h2723
  37. Bandeira F, Cusano NE, Silva BC, Cassibba S, Almeida CB, Machado VCC, Bilezikian JP. Bone disease in primary hyperparathyroidism. Arq Bras Endocrinol Metabol. 2014;58(5):553–61. PMID: 25166047. PMCID: PMC4315357. https://doi.org/10.1590/0004-2730000003381
  38. Ильичева Е.А., Берсенев Г.А., Григорьев Е.Г. Случай поздней диагностики гигантской аденомы околощитовидной железы в сочетании с фиброзно-кистозным остеитом и бурой опухолью верхней челюсти: клиническое наблюдение. Проблемы эндокринологии. 2021;67(2):49–56. [Ilyicheva EA, Bersenev GA, Griroryev EG. The case of late diagnosis of giant parathyroid adenoma in combination with fibrocystic osteitis and brown tumor of the upper jaw: A case report. Problemy endokrinologii = Problems of Endocrinology. 2021;67(2):49–56 (In Russ.)]. PMID: 34004103. PMCID: PMC8926140. EDN: UBKUEQ. https://doi.org/10.14341/probl12713
  39. Мокрышева Н.Г., Еремкина А.К., Мирная С.С., Володичева В.Л., Паневин Т.С., Мельниченко Г.А. Патологические изменения в суставах и мышцах при первичном гиперпаратиреозе. Остеопороз и остеопатии. 2018;21(4):10–18. [Mokrysheva NG, Eremkina AK, Mirnaya SS, Volodicheva VL, Panevin TS, Melnichenko GA. Joint and muscle involvement in primary hyperparathyroidism. Osteoporoz i osteopatii = Osteoporosis and Osteopathy. 2018;21(4):10–18 (In Russ.)]. EDN: CGMCPI. https://doi.org/10.14341/osteo9783
  40. Walker MD, Shane E. Hypercalcemia: A review. JAMA. 2022;328(16):1624–36. PMID: 36282253. https://doi.org/10.1001/jama.2022.18331
  41. Basok AB, Rogachev B, Haviv YS, Vorobiov M. Treatment of extreme hypercalcaemia: The role of haemodialysis. BMJ Case Rep. 2018;2018:bcr2017223772. PMID: 29866671. PMCID: PMC5990060. https://doi.org/10.1136/bcr-2017-223772.bcr2017223772
  42. Tebben PJ, Singh RJ, Kumar R. Vitamin D-mediated hypercalcemia: Mechanisms, diagnosis, and treatment. Endocr Rev. 2016;37(5):521–47. PMID: 27588937. PMCID: PMC5045493. https://doi.org/10.1210/er.2016-1070
  43. Елфимова А.Р., Еремкина А.К., Реброва О.Ю., Ковалева Е.В., Мокрышева Н.Г. Прогнозирование развития гипокальциемии у пациентов с ПГПТ в 1–3 сутки после паратиреоидэктомии. Эндокринная хирургия. 2023;17(3):50–60. [Elfimova AR, Eremkina AK, Rebrova OYu, Kovaleva EV, Mokrysheva NG. Prediction of the development of hypocalcemia in primary hyperparathyroidism patients 1-3 days after radical parathyroidectomy. Endokrinnaya khirurgiya = Endocrine Surgery. 2023;17(3):50–60 (In Russ.)]. EDN: DJKMHC. https://doi.org/10.14341/serg12824
  44. Bilezikian JP. Hypoparathyroidism. J Clin Endocrinol Metab. 2020;105(6):1722–36. PMID: 32322899. PMCID: PMC7176479. https://doi.org/10.1210/clinem/dgaa113
  45. Liu C, Tang L, Goel P, Chambers T, Kokot N, Sinha U, Maceri D. A practical mathematic method to predict and manage hypocalcemia after parathyroidectomy and thyroidectomy. Ann Otol Rhinol Laryngol. 2020;129(1):70–77. PMID: 31510765. https://doi.org/10.1177/0003489419876291
  46. Schneider DF, Mazeh H, Chen H, Sippel RS. Predictors of recurrence in primary hyperparathyroidism: An analysis of 1386 cases. Ann Surg. 2014;259(3):563–68. PMID: 24263316. PMCID: PMC4250051. https://doi.org/10.1097/sla.0000000000000207
  47. Carsote M, Nistor C. Forestalling hungry bone syndrome after parathyroidectomy in patients with primary and renal hyperparathyroidism. Diagnostics (Basel). 2023;13(11):1953. PMID: 37296804. PMCID: PMC10252569. https://doi.org/10.3390/diagnostics13111953
  48. Lorenz FJ, Goldenberg D. Hypocalcemia after parathyroidectomy in patients taking proton pump inhibitors. Am J Otolaryngol. 2023;44(2):103761. PMID: 36586320. PMCID: PMC10033382. https://doi.org/10.1016/j.amjoto.2022.103761
  49. Jain N, Reilly RF. Hungry bone syndrome. Curr Opin Nephrol Hypertens. 2017;26(4):250–55. PMID: 28375869. https://doi.org/10.1097/mnh.0000000000000327
  50. Fackelmayer OJ, Wu JX, Yeh MW. Endocrine surgery: Management of postoperative complications following endocrine surgery of the neck. Surg Clin North Am. 2021;101(5):767–84. PMID: 34537142. https://doi.org/10.1016/j.suc.2021.05.019
  51. Acharya R, Kopczynska M, Goodmaker C, Mukherjee A, Doran H. Vitamin D repletion in primary hyperparathyroid patients undergoing parathyroidectomy leads to reduced symptomatic hypocalcaemia and reduced length of stay: A retrospective cohort study. Ann R Coll Surg Engl. 2022;104(1):41–47. PMID: 34727512. PMCID: PMC10335014. https://doi.org/10.1308/rcsann.2021.0078
  52. Mulkareddy V, Bhalla V, Upadhye S, Siddam P. The diagnostic dilemma of sarcoidosis: A case of acute hypercalcemia. Cureus. 2020;11;12(9):e10399. PMID: 33062519. PMCID: PMC7549992. https://doi.org/10.7759/cureus.10399

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1. JATS XML
2. Fig. 1. Regulation of parathyroid hormone secretion and its effect on kidney function

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3. Fig. 2. Formation and role of vitamin D in calcium metabolism and its impact on bone metabolism

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4. Fig. 3. Relationship between serum parathyroid hormone and calcium levels in normal state and in primary hyperparathyroidism

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5. Fig. 4. Degrees of severity of hypercalcemia

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