What are additional causes of hypercalcemia?

Updated: Apr 29, 2020
  • Author: Thomas E Green, DO, MPH, MMM, CPE, FACEP, FACOEP; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

These include the following:

  • Neoplasms (nonparathyroid) - Metastasis to the bone from breast, multiple myeloma, and hematologic malignancies (Breast cancer is one of the most common malignancies responsible for hypercalcemia.)

  • Nonmetastatic (humoral-induced) - Ovary, kidney, lung, head and neck, esophagus, cervix, lymphoproliferative disease, multiple endocrine neoplasia, pheochromocytoma, and hepatoma

  • Pharmacologic agents - Thiazide, calcium carbonate (antacid), hypervitaminosis D, hypervitaminosis A, lithium, milk-alkali syndrome, and theophylline toxicity

  • Endocrinopathies (nonparathyroid) - Hyperthyroidism, adrenal insufficiency, and pheochromocytoma

  • Familial hypocalciuric hypercalcemia

  • Tertiary hyperparathyroidism - Post–renal transplant and initiation of chronic hemodialysis

  • Miscellaneous - Immobilization, hypophosphatasia, primary infantile hyperparathyroidism, AIDS, and advanced chronic liver disease

A study by Meehan et al found that 26.2% of patients with bipolar disorder undergoing lithium treatment had hypercalcemia. Out of a study population consisting of patients with bipolar disorder being treated with lithium, patients with bipolar disorder not being treated with lithium, and controls, hypercalcemia occurred in 87 individuals, including 82 (94.3%) of those undergoing lithium therapy. [19]

In a retrospective, observational study from Australia of emergency department patients, Taylor et al reported that risk variables for hypercalcemia included not only aforementioned factors—vomiting, polyuria, confusion, hyperparathyroidism, and cancer—but also female sex and type 1 diabetes mellitus. [20]


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