Hypercalcemia history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
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Overview
History
Symptoms
"Bones, stones, groans, and psychic moans" is a saying which will help you remember the signs and symptoms of hypercalcemia; if it is chronic it can result in urinary calculi (renal stones or bladder stones). Abnormal heart rhythms can result, and EKG findings of a short QT interval and a widened T wave suggest hypercalcemia.
Symptoms are more common at high calcium blood values (12.0 mg/dL or 3 mmol/l). Severe hypercalcemia (above 15-16 mg/dL or 3.75-4 mmol/l) is considered a medical emergency: at these levels, coma and cardiac arrest can result.
Hypercalcemia per se can result in:
Complete List of Possible Symptoms
- Renal stones
- Headaches
- Bone pain and/or weakness
- Abdominal pain
- Confusion
- Nausea/vomiting
- Constipation
- Peptic ulcer disease
- Hallucinations
- Bradycardia
- Insulin resistance
- Glucose intolerance
- Muscle weakness
- Hyporeflexia
- Polyuria
- Shortened QT interval
- Pancreatitis
- Psychosis
- Depression
- Anxiety
History
Although majority of patients with hyperparathyroidism have non-specific history but a detailed and thorough history from the patient is necessary. The patient may have a positive history of:[1]
- Kidney stones
- Bone pain and tenderness
- Fragile bones of the limbs and spine that can break easily
- Frequent and excessive urination
- Gastrointestinal symptoms like epigastric pain, constipation, indigestion, nausea, and vomiting
- Feeling tired, ill, and weak
- Depression and memory disturbances
- Vitamin D deficiency
- Chronic renal failure in case secondary hyperparathyroidism is suspected
- Renal transplant in case tertiary hyperparathyroidism is suspected
- Use of medications including thiazide diuretics and lithium.
- Neck radiation
Symptoms
Asymptomatic Hyperparathyroidism
The majority of patients with primary hyperparathyroidism are asymptomatic. Asymptomatic primary hyperparathyroidism patient was expected to dvelop signs ans symptoms, but most of the patients does not becomes symptomatic with time. The hallmark of primary hyperparathyroidism is asymptomatic hypercalcemia.[2]
Symptomatic Hyperparathyroidism
A few of patients that do present with symptoms, they are commonly associated with the effects of an increased level of calcium. Calcium is involved in trans-synaptic communication within nervous system and high blood calcium levels have a direct effect on the nervous system. As a result, most of the symptoms of parathyroid diseases are neurological. The most common symptom is fatigue. Other symptoms include lethargy, memory disturbances, depression, lack of concentration, and sleep disturbances. Other manifestations of hyperparathyroidism may include kidney stones and the musculoskeletal symptoms (bone pain due to the development of osteoporosis).
Common symptoms
The symptoms of hyperparathyroidism can be remembered by the rhyme "painful bones, kidney stones, abdominal groans, psychic moans, and fatigue overtones":[3]
- "Painful bones" (bone pain)
- "Kidney stones" (Kidney stones)
- "Abdominal groans" (abdominal pain, gastroesophageal reflux)
- "Psychic moans" (depression, memory disturbances)
- "Fatigue overtones" (complaints of not feeling well, lethargy, fatigue)
Less common symptoms
Less common symptoms are usually present in severe disease and includes:
- Confusion
- Constipation
- Decreased libido
- Hypertension
- Headaches
- Heart palpitations which are often due to bouts of atrial fibrillation
- Gastroesophageal reflux
- Lack of concentration
- Loss of appetite
- Left ventricular hypertrophy
- Nausea and vomiting
- Peptic ulcers
- Polydipsia
- Polyuria
- Thinning of hair
References
- ↑ Silverberg SJ, Bilezikian JP (1996). "Evaluation and management of primary hyperparathyroidism" (PDF). J. Clin. Endocrinol. Metab. 81 (6): 2036–40. doi:10.1210/jcem.81.6.8964825. PMID 8964825.
- ↑ Marcocci, Claudio; Cetani, Filomena (2011). "Primary Hyperparathyroidism". New England Journal of Medicine. 365 (25): 2389–2397. doi:10.1056/NEJMcp1106636. ISSN 0028-4793.
- ↑ Elaraj DM, Clark OH (2008). "Current status and treatment of primary hyperparathyroidism". Perm J. 12 (1): 32–7. PMC 3042336. PMID 21369510.