                               
|
|
 High
blood calcium is not normal. If you have a blood test that shows high
blood calcium, then your doctor is obligated to check it out. It is never
normal to have high calcium levels in your blood. Hypercalcemia is the
medical term for high blood calcium. This page is one of the
first pages of Parathyroid.com that you should read if you just got back
from the doctor and he/she told you that your blood calcium was too high. As you
will see, over 98% of all cases of too much blood calcium are due to
parathyroid disease and hyperparathyroidism. This page will list all of
the causes of high blood calcium and discuss what tests are used to
determine what is causing the high calcium. Keep reading. Editorial
Note: Since we put this page on line we are getting more emails asking
if your doctor should check you for cancer if your calcium is high. The
answer is almost always NO. Parathyroid disease is the cause of high
calcium at least 98% of the time. Measure parathyroid function first and
you will find the reason for your high blood calcium.
IMPORTANT-- There is a lot
written about high calcium being caused by cancer, however, this is not very
common. Let us say that again... It is very RARE for high blood calcium to
be due to cancer. We know that if you search "high
calcium" on the Internet you will find lots of web sites that talk
about high calcium being caused by cancer... but relax, that's just
because there are a LOT more websites in the world discussing cancer than
there are websites dedicated to parathyroid disease. HOWEVER, if you are
sitting at a computer researching about your own high calcium, then you
are almost guaranteed to NOT have cancer. Keep reading and you will see
that people who are not in the hospital dying of cancer and have a high calcium on a blood
test almost never have cancer and almost always DO have hyperparathyroidism. This must be fixed, but it is
not cancer... its caused by a hormone problem. Now that you know you don't
have cancer... let's read about all the causes of high blood calcium. Other
areas of this web site tell you what to do about it.
Causes of High Blood Calcium and Too Much Calcium in the Blood.
High Blood Calcium Cause Number 1: Hyperparathyroidism (abnormal function of the parathyroid glands).
Over 98% of ALL people who have a blood test that shows too much
calcium will have a parathyroid problem. The remainder of this site is
about parathyroid disease, so you have come to the right place. We will
not go into any detail about hyperparathyroidism on this page. Parathyroid
glands are little glands in the neck that control the calcium in the
blood. Occasionally one of them will grow into a benign tumor and cause
high blood calcium. It is virtually 100%
benign (not cancer), can be cured in most people (by expert surgeons) in
under 20
minutes, and is almost always associated with some symptoms. If you have
high calcium, you should start at the beginning of this site and read about
your parathyroid problem. PARATHYROID DISEASE IS THE CAUSE OF ALMOST ALL HIGH
CALCIUM LEVELS. IT MUST BE FIXED. IT SHOULD NOT BE IGNORED OR WATCHED.
This is all we'll say here... but we say lots on this web site! If you are
sitting in front of a computer reading this page and your calcium is high,
then you are almost guaranteed to have a parathyroid problem NOT cancer!
TESTS NEEDED: We discuss parathyroid disease on dozens of pages
on this web site. In summary, you need to have your calcium and PTH
measured... that's it! Preferably, you should have TWO different
types of blood calcium measured: 1) serum calcium, and 2) ionized calcium.
Parathyroid Hormone (PTH) must also be measured. This is all that is
needed to make the diagnosis of hyperparathyroidism in more than 95% of
patients. You do NOT need any x-rays or scans to make the diagnosis of
hyperparathyroidism. Scans are NOT to be used to determine if you have
this disease. Go to the home page and read all the
pages on parathyroid disease in order, or, the BEST page is our page on
how to diagnose parathyroid disease.
High Blood Calcium Cause Number 2: Cancer
(less than 1% of cases of high calcium are due to cancer... far less than
0.01% of cases of high calcium in people sitting in front of their computer
are due to cancer) (you don't have cancer!).
Cancer is a catch-all phrase that includes 122 different types of
malignancies known to occur in humans. Of those 122 types of cancer, there
are 5 that are known to be associated with high calcium levels in the
blood. About 10% to 15% of people with one of these types of cancer will
have a high calcium level at one time or another. Very high blood calcium
(above 13) is the most common life-threatening emergency associated with
these cancers, and is typically seen at the end-stage of the cancer
(end-stage means the patient is in real bad shape and near the end).
Thus, we can take several lessons away from these facts: 1) Cancer is
almost never detected in a patient because the doctor noticed a high
calcium level (this isn't how cancers present themselves), 2) High calcium
due to cancer almost always occurs in people who are quite sick from their
cancer--its not a surprise that they have cancer, 3) High calcium due to
cancer is usually found in people who are in the hospital--they are sick
from the cancer, 4) if you have high calcium and you aren't sick from
cancer, then you are almost guaranteed to you have a parathyroid
problem and not cancer.
The types of cancer known to be associated with high blood calcium
are:
 | Multiple Myeloma (this is discussed separately below). |
| Lung Cancer (squamous cell cancer of the lung, not all lung cancers) |
| Breast Cancer (advanced disease) |
| Kidney Cancer |
| Squamous Cell Cancer of the Head and Neck |
Cancer causes hypercalcemia (high blood calcium) in two ways. The first
is easiest to understand. Occasionally certain cancers will spread from
their site of origin to other parts of the body. Some cancers (all those
listed above) have a propensity to spread to the bone. This is called metastasis.
When the metastatic cancer spreads to the bones it grows there and slowly
eats away at the center of the bone--this releases calcium into the blood.
The second way that some cancers can increase your blood calcium is via
hormones and proteins that the tumor can secrete. One of these hormones is
called "parathyroid-related-peptide". These hormones can
circulate in the blood and cause the bones to release calcium just like
parathyroid hormone does. Some of our patients will have had a PTHrp test
done prior to them being sent to us for parathyroid surgery. This is your
doctor's way of checking to make sure that your high calcium is not caused
by a cancer. We do not require this test to be done, nor should you ask
your doctor for it. In our opinion, this test is WAY over used (but at least
you understand what it's for). Do NOT ask for this test.
Multiple Myeloma. Multiple myeloma is a
cancer (it is in the list above), but we write more about it here because it is the
most common cancer cause of high calcium. Nearly half of all people with myeloma have
hypercalcemia at some stage during their disease. Multiple myeloma is a cancer of the plasma
cells (a type of white blood cell) that are found in the bone marrow.
Plasma cells develop from B lymphocytes (a different type of white blood
cell) and they produce antibodies that help the body fight infection
(bacteria and viruses). When a plasma cell becomes malignant it will divide
many times and produce many copies
of itself that form tumors in the bone marrow. Over a period of years
these tumor erode the inside of the bone, producing holes in the bones
(called "lytic" lesions). Since the malignant
cells are clones they all act exactly alike and they all produce the same antibody
molecule that is secreted into
the blood (this is what your doctor will measure).
Multiple myeloma is often detected during routine wellness testing
where it shows up as an abnormally high amount of protein in the blood, a
high calcium
level, and often increased amounts of protein
in the urine. To make the diagnosis your doctor will order a protein
electrophoresis to be done. This test will examine the proteins in your
blood to see if there is a large amount of one type of antibody present...
and if there is, the diagnosis of multiple myeloma is made. About 15% of
patients that we see for parathyroid disease have had protein
electrophoresis test performed to make sure they don't have multiple
myeloma prior to them coming for treatment of their parathyroid disease.
We believe that this is NOT necessary and this test is performed way too
often. This is often done by endocrinologists who do not see parathyroid
patients very often and they order a BUNCH of tests on your first visit
(shotgun approach). Remember, almost everybody with high calcium will have
parathyroid disease. If your doctor does not order a protein
electrophoresis on your first visit, then good for them. You are almost
guaranteed to never need it and you have a good doctor.
High Blood Calcium Cause Number 3: Sarcoidosis
Sarcoidosis, or "sarcoid" for short, is a disease where the
body’s immune system is over activated for unclear reasons. Sarcoid can
often go many years before being detected, and is often found by accident
when a chest x-ray is obtained for some other reason. Other patients can
have symptoms such as cough or shortness of breath. Sarcoid often resolves
spontaneously and therefore treatment is not always necessary. If a
patient has symptoms the disease is usually treated with steroids. The
cause of sarcoid is unknown. How sarcoid causes high calcium is not known,
but is probably due to the same two ways that cancer causes increased
calcium. This disease is very rare.
High Blood Calcium Cause Number 4: Excess Vitamin D Intake
Vitamin D is extremely important in helping maintain the balance of
calcium in our bodies. In fact, that's all that vitamin D does!
Vitamin D has a direct effect on the intestines and encourages the
intestines to absorb calcium from the food that you have eaten (this is
why most milks are fortified with vitamin D). Vitamin D also has an effect
on the kidneys and tells the kidneys to not let any calcium escape into
the urine. Therefore, it is possible for a person to take too much vitamin
D so that they absorb too much calcium from their diet and hold on to too
much calcium in their kidneys... and their calcium goes high. In the real
world, this does not really happen. Normal parathyroid glands won't allow
the calcium to go high.
I must tell you... although taking a bunch of Vit D so that you absorb
lots of calcium from your diet which makes your blood calcium go high sounds quite plausible... it is so rare that it is hard for me to believe
that I'm spending the time writing about it, and I'm sorry to waste the 20
seconds it took for you to read it. If you are taking
dozens of vitamin D pills per day and your calcium goes high... then stop
taking all the vitamin pills.
High Blood Calcium Cause Number 5: Certain Drugs
It is possible for certain drugs that people are prescribed for high
blood pressure to have an effect on the kidney in such a way that the
kidney doesn't let enough calcium escape the blood into the urine... and
the excess calcium shows up as a high blood calcium test. The one drug
that is typically associated with this is HCTZ (hydrochlorothyazide) which
is a "water pill" used for blood pressure. If you have high
blood calcium and you are on this drug your doctor will probably take you
off of this medicine and then re-check your blood in a few weeks. Almost
all the time this is not the problem (it is very rare) and your blood
calcium will continue to be high and you will have hyperparathyroidism
(like more than 98% of people do who have high blood calcium). In reality,
this "excuse" for high blood calcium is way over used and is 90%
BS. Be careful of letting a doctor say that your blood calcium is high
because you are on this blood pressure medicine. It can happen, but it is
WAY over used as the excuse. It is MUCH more common for you to have a
parathyroid problem and just coincidentally be on this very common
drug. Be careful here, folks... this is a common mistake made that
delays the diagnosis of parathyroid disease in at least 15% of all
patients we see. Make sure your doctor doesn't just "forget"
about the high calcium and just blame it on this drug. That is a mistake
almost all the time.
High Blood Calcium Cause Number 6: Milk-Alkali Syndrome.
Wow! Is it 1965 again? Milk-Alkali Syndrome is a phenomenon
that occurs when a patient has a stomach ulcer and they self treat it by
taking lots of antacids and drinking lots of milk. They do this so they
can get relief of the pain in their stomach due to too much acid in the
stomach. They buy lots of antacids like TUMS and eat lots of them. They
also find that drinking milk makes their stomach feel better. However, the
antacids have lots of calcium in them, and so does the milk. Therefore
these people are eating LOTS of calcium every day and if it gets absorbed
into the blood then they will have high blood calcium. Here is the good
news... this is so rare these days that 99.99% of doctors will never see
this in their lifetimes. Why??? Because we have lots better ways of
treating stomach ulcers (Zantac, Prilosec, Nexium, Tagamet, etc, etc,
etc). People don't treat ulcers with antacids like they used to. It is a
common mistake for doctors to blame a patient's high blood calcium on
eating too much calcium. Listen carefully... calcium is the most highly
regulated element in our bodies because it runs our brain. NORMAL
parathyroid glands will not allow people to have high blood calcium
REGARDLESS of how much calcium they eat. If your doctor says "your
calcium is high because you are eating too much dairy products and taking
vitamins", then you print this page and take it to him/her. Normal
parathyroid glands will NOT let this happen...
High Blood Calcium Cause Number 7: Paget's Disease of the Bone.
Paget's Disease (osteitis deformans) is a chronic skeletal disorder
that often results in enlarged or deformed bones in one or more regions of
the skeleton. Excessive bone breakdown and formation can result in bone,
which is dense but fragile. This continued bone breakdown can be a cause
of hypercalcemia (too much calcium in the bone). It is extremely uncommon
for Paget's disease to be diagnosed after a patient had a routine blood
test that showed a high calcium level. Thus, we put it on this page for
completeness sake, but trust me, if you are on this page because you have
a high calcium level in your blood... you don't have this. For more about
Paget's Disease click
here.
Smart Calcium Facts
 Calcium,
the fifth most common element in the body, exists almost entirely
(99%) as crystalline hydroxyapatite in bones and teeth.
Calcium
is used by nerve cells to propagate an impulse, and by muscle
cells to contract. Humans want extremely regulated calcium levels
because our brains (and entire nervous system) rely on calcium. If
the calcium level in our blood is too high or too low, we get
symptoms in our nervous system (click
here to read more about symptoms of high calcium).
There
are three ways that calcium is present in our blood: 1)
protein-bound (45%); 2) attached to small diffusible anions such
as citrate, lactate, phosphate and bicarbonate (10%); and ionized
(45%).
Doctors
almost always measure just one type of calcium (serum calcium).
This is the calcium that gets measured when a routine
"calcium" level is ordered. This measures the amount of
all three types of calcium present in the blood and this is the
only test that is needed almost all the time.
Ionized
calcium is very important to measure in patients with
hyperparathyroidism. Ionized calcium relates to the symptoms a
patient will have with hyperparathyroidism. If your calcium is
high normal then make sure your ionized calcium is measured since
many people with hyperparathyroidism will have serum calcium
levels that are normal, but their ionized calcium levels are high.
It is the ionized calcium levels that make people feel bad! The
problem is that most doctors aren't aware that ionized calcium
should be measured in parathyroid patients, and very few
understand that the symptoms parathyroid patients get are related
to high ionized calcium levels. If your doctor doesn't believe
your high calcium level is causing you symptoms... print this and
ask him/her to measure your ionized calcium.
Hypercalcemia
is defined as a serum calcium concentration above 10.4 mg/dL (2.6
mmol/L in Canada, Europe, and Asia). A serum calcium concentration
>14.0 mg/dL (>3.5 mmol/L) requires immediate therapy.
Although there are many causes of hypercalcemia, primary
hyperparathyroidism is the most common cause in the general
population, and cancer and other non-PTH-mediated causes are most
common in hospitalized patients. If
you are sitting in front a computer and you have high calcium,
then the odds of you having hyperparathyroidism as the cause of
your high calcium is about 99.9%. The odds of one of the other
problems (like cancer) listed above being the cause of your high
calcium is near zero. Stop worrying, and don't let your doctor do
all sorts of silly tests looking for cancer. You have
hyperparathyroidism until proven otherwise. It is easy to fix, and
must be fixed. Parathyroid
Hormone Related Peptide (PTHrp) is not a perfect test to determine
who's high calcium is due to cancer and who's is not. About 3% of
normal people will have a high PTHrp and, 8% of people with
hyperparathyroidism will have a high level. On the flip side, 12%
of people with hypercalcemia due to cancer will have normal PTHrp
levels (it should be high). Thus, this test like all tests have a
specific error rate. Please don't print this page and take it to
your doctor demanding that this test be done. It is way over used! |
If you want to read more about calcium levels in the
blood, how to diagnose parathyroid disease, and look at a graph of
normal and high calcium levels, then go to our page on Diagnosing
Parathyroid Disease. This page has some very nice graphs. Remember,
you don't have cancer, you almost certainly have hyperparathyroidism
which is easy to fix. Spend some time here and learn about parathyroid
glands. Remember, an expert surgeon should be able to fix this problem
in about 20 minutes or less. Also... you may want to go to our home
page and start from the beginning.
This page was last updated 05/13/2009 |
