Hypercalcemia Treatment in Delhi, India

Hypercalcemia is caused by abnormally high blood calcium levels (above 10.5 mg/dL). Calcium helps build and maintain strong bones and is essential for muscle function, nerve signalling, and other bodily processes, but too much calcium can cause health problems such as kidney failure or heart disease.

The health condition can be caused by various underlying problems and medications that affect the body’s ability to process vitamin D and how the kidneys remove calcium. Here are some common causes of hypercalcemia:

Primary Hyperparathyroidism

PHPT occurs when one or more of the parathyroid glands produce too much parathyroid hormone (PTH), leading to high levels of calcium in the blood (hypercalcemia). Some common causes of the disorder of the parathyroid glands include parathyroid adenoma, parathyroid hyperplasia, and parathyroid carcinoma.

Certain Types of Cancers

Malignant/cancerous tumours produce PTHrP, a proteinaceous hormone, which mimics the effects of parathyroid hormone (PTH). It causes bones to release more calcium into the bloodstream, promoting renal calcium reabsorption, which leads to humoral hypercalcemia of malignancy. 

Vitamin D or Calcium Overdose

Overuse of vitamin D supplements (vitamin D toxicity) can cause the calcium level in the blood to increase drastically. In some cases, a granulomatous disease such as sarcoidosis or tuberculosis can lead to excessive vitamin D production by immune cells, causing the body to absorb more calcium than necessary. Milk-Alkali Syndrome, a condition linked to excessive intake of calcium supplements and milk, can also lead to hypercalcemia.

Endocrine Disorders 

Two common endocrine disorders that can cause hypercalcemia are thyrotoxicosis and Addison’s Disease. In thyrotoxicosis, thyroid hormone levels in the bloodstream increase, causing bones to release excess calcium. Addison’s Disease causes a person’s cortisol levels to drop, leading to increased intestinal calcium absorption.

Certain Medications 

Thiazide diureticssuch as Chlorthalidone, Indapamide, Metolazone, and Bendroflumethiazideaffect the kidneys’ ability to remove calcium from the body, leading to mild hypercalcemia, especially in people with primary hyperparathyroidism and chronic kidney disease.

From underlying medical conditions to lifestyle choices, several factors can contribute to the development of hypercalcemia. Individuals at high risk of developing the disorder should maintain a healthy lifestyle and come up with a plan to manage the following hypercalcemia risk factors:

Lifestyle

A sedentary lifestyle can lead to bone loss. As a result, bones release excess calcium into the bloodstream, causing blood calcium levels to increase drastically. Apart from an inactive lifestyle, alcohol can also affect bone health, potentially leading to disruption of calcium homeostasis, which increases the risk of hypercalcemia. 

Genetic Factors 

Mutations or inherited conditions that affect the way in which calcium is regulated in the body can lead to hypercalcemia. Here are some genetic disorders linked to hypercalcemia:

Familial Hypocalciuric Hypercalcemia 

A genetic disorder typically caused by mutations in the CASR gene, FHH affects the body’s ability to regulate calcium levels, leading to mild hypercalcemia. Unlike primary hyperparathyroidism, FHH is usually asymptomatic, and treatment is not required. 

Multiple Endocrine Neoplasia Type 1 (MEN1)

MEN1 is a genetic syndrome caused by mutations in the MEN1 gene. It can cause the parathyroid glands to become overactive. As a result, they produce too much parathyroid hormone, leading to hypercalcemia.

Rickets and Osteogenesis Imperfecta

Osteogenesis imperfecta (a condition characterized by brittle bones) or genetic forms of rickets can lead to abnormal bone metabolism. This can cause bones to release excessive calcium into the bloodstream, leading to hypercalcemia.

Age 

As people age, their bone density typically decreases, leading to a higher risk of osteoporosis, a bone disease that makes one’s bones thinner and weaker. When weak bones break, they release excess calcium into the bloodstream, causing hypercalcemia. Also, as a person ages, their kidneys and parathyroid glands may fail to regulate calcium levels in the body effectively. 

Diet

A diet that mainly includes foods high in calcium, phosphorus ( can disrupt the balance between calcium and phosphorus levels), and vitamin-D can affect the body’s ability to regulate calcium levels, potentially leading to hypercalcemia.

While mild hypercalcemia may not cause noticeable symptoms, severe hypercalcemia can result in fatigue, confusion, digestive disorders, and even serious complications such as kidney damage or abnormal heart rhythms. Here are some common symptoms of the health condition:

Fatigue and Weakness

High calcium levels disrupt nerve function and the balance of ions needed for proper muscle function, causing muscle weakness, sluggishness, and tiredness. Abnormally high calcium levels can also decrease the glomerular filtration rate, a common cause of fatigue in people with hypercalcemia. 

Frequent Urination 

High calcium levels can lead to nephrogenic diabetes insipidus, which causes the body to produce too much urine. Too much calcium in the kidneys inhibits the reabsorption of water, leading to increased urine volume.

Excessive Thirst

When hypercalcemia causes the body to produce more urine than normal, dehydration occurs. The brain’s thirst centre in the hypothalamus is stimulated in response to dehydration, causing the person to feel thirsty all the time. 

Nausea and Vomiting 

The autonomic nervous system helps regulate digestion. Hypercalcemia can impair its function, leading to sluggish digestion and nausea. The condition also causes the movement of food through the stomach and intestines to slow down, leading to nausea, vomiting, and constipation. 

Confusion and Memory Problems 

Elevated calcium levels can slow down communication between neurons, leading to cognitive impairment. Hypercalcemia can lead to decreased neurotransmitter activity, which can cause difficulty processing and recalling information.

Doctors use lab test reports to check serum calcium levels. In some cases, imaging and urine tests may also be used to determine the underlying cause of high calcium levels. Here are some common tests that can help detect high calcium levels:

Blood Tests 

One of the most common tests used to diagnose hypercalcemia is the serum calcium test. A person is said to have hypercalcemia when their calcium levels exceed 10.5 mg/dL. Because calcium binds to proteins, corrected calcium level or ionized calcium level (the biologically active form) is often measured. 

Parathyroid Hormone Test 

A PTH test helps a doctor determine if the cause of elevated calcium levels is related to the parathyroid glands. High PTH levels (60-150 pg/mL) are diagnostic of primary hyperparathyroidism, whereas low PTH levels are indicative of vitamin D toxicity or malignancy. 

Kidney Function Test 

Doctors use kidney function tests to detect abnormally high urine calcium levels. 

Hypercalcemia can impair kidney function, causing the glomerular filtration rate to decline. Reduced GFR can result in increased serum creatinine levels (kidney function tests measure serum creatinine levels), a common sign of kidney dysfunction.

Electrocardiogram (ECG)

Doctors study electrocardiographic changes to diagnose hypercalcemia. In severe hypercalcemia, Osborn waves (small positive deflections at the end of the QRS complex) may be seen. In some cases, moderate PR interval prolongation is observed. 

Imaging Tests 

Some imaging tests that help doctors diagnose primary hyperparathyroidism, malignancies, and other conditions affecting calcium metabolism are-

• Neck ultrasound-Helps detect parathyroid adenomas (a common cause of primary hyperparathyroidism).
• CT scan- Used to detect malignancies that can cause hypercalcemia
• Whole-Body PET/CT Scan- Can be used to detect occult malignancies that may cause hypercalcemia.

While mild cases can usually be managed with lifestyle changes, more severe cases require medical intervention. Here are some hypercalcemia treatment options:

Dietary Modification 

Patients with mild hypercalcemia are often advised against using vitamin D and calcium supplements. They should also reduce their intake of calcium and vitamin D rich foods, cut down on alcohol, and add high-fiber foods such as whole grains and vegetables to their diet. 

Intravenous (IV) Hydration

0.9% Normal saline, a sterile solution of sodium chloride (NaCl) in water, is often administered to patients with moderate to severe hypercalcemia. The solution increases blood volume and promotes calcium excretion through the kidneys.

Glucocorticoids

Glucocorticoids are steroid hormones produced by the adrenal glands.Particularly effective when hypercalcemia is caused by granulomatous diseases,glucocorticoids inhibit the production of calcitriol (active vitamin D) in the kidneys, reducing calcium absorption. They also promote calcium excretion through the kidneys, helping manage serum calcium levels.

Calcitonin 

A hormone produced by the parafollicular cells (C cells) of the thyroid gland, calcitonin lowers blood calcium levels by helping the kidneys excrete calcium. It also reduces calcium reabsorption in the renal tubules. 

Bisphosphonates

A class of drugs used to prevent and treat bone loss (osteoporosis) and other bone-related conditions known as bisphosphonates, slow down bone resorption, and inhibit osteoclast activity, reducing the amount of calcium released from bones.

Hypercalcemia can be prevented by managing underlying risk factors and maintaining a healthy lifestyle. Those at high risk of the disorder should regularly monitor their calcium and vitamin D levels and seek medical attention immediately if they sense something is amiss. Here are some hypercalcemia prevention tips:

Stay Hydrated

Water helps the kidneys remove excess calcium from the body through urine. Drinking more water is a great way to decrease calcium reabsorption in the kidneys, which causes more calcium to be excreted from the body. 

Realise the Importance of Regular Physical Activity

Weight-bearing exercises such as walking and jogging help improve bone health. Healthy bones do not release excess calcium into the bloodstream. Physical activity improves kidney function and regulates parathyroid hormone levels, reducing a person’s risk of developing hypercalcemia. 

Manage Underlying Conditions 

By managing underlying conditions such as hyperparathyroidism, kidney disease, or any other health issue that can contribute to high calcium levels, one can reduce their risk of hypercalcemia. People living with health conditions that can cause hypercalcemia should regularly monitor their calcium levels. 

Understand Your Medicines 

Thiazide diuretics, lithium and calcium and vitamin D supplements, can raise calcium levels in blood. A doctor can help an individual at high risk of developing hypercalcemia decide whether they should use these medicines and supplements or lower their dose (if they are already using them).

How does hypercalcemia affect the body?

Hypercalcemia can impact multiple organs, including the kidneys, bones, digestive system, and heart. It can lead to kidney stones, bone loss, abdominal pain, and irregular heart rhythms.

Is hypercalcemia a serious condition?

Yes, if left untreated, hypercalcemia can lead to severe complications such as kidney failure, heart issues, and neurological impairments.

Can mild hypercalcemia go away on its own?

In some cases, mild hypercalcemia may resolve without treatment, especially if caused by temporary factors like dehydration. However, persistent high calcium levels require medical evaluation.

Does hypercalcemia always cause symptoms?

No, mild cases may not cause noticeable symptoms. However, moderate to severe hypercalcemia can lead to fatigue, nausea, kidney problems, and confusion.

Can diet contribute to hypercalcemia?

While excessive calcium intake from food is rarely a direct cause, overuse of calcium supplements or vitamin D supplements can contribute to elevated blood calcium levels.

Should I stop consuming dairy products if I have hypercalcemia?

Not necessarily. Your doctor will determine whether dietary adjustments are needed based on your calcium levels and underlying condition.

Does drinking more water help lower calcium levels?

Yes, staying well-hydrated can help the kidneys flush out excess calcium and may prevent kidney stones associated with hypercalcemia.

Can exercise help manage hypercalcemia?

Moderate exercise may support bone health and calcium balance, but excessive immobility can worsen hypercalcemia by increasing calcium release from bones.

Can hypercalcemia be managed without medication?

Mild cases may be managed with hydration and dietary changes, but moderate to severe cases often require medications or other interventions.

Are calcium supplements safe if I have hypercalcemia?

No, calcium supplements should be avoided unless specifically recommended by a doctor. Unnecessary supplementation can worsen the condition.

Can hypercalcemia be a side effect of other medications?

Yes, certain medications, including some diuretics and lithium, can contribute to elevated calcium levels. Your doctor may adjust your medications if necessary.

Is hypercalcemia linked to kidney disease?

Yes, hypercalcemia can contribute to kidney damage, and existing kidney disease may make it harder for the body to regulate calcium levels.

Can hypercalcemia be associated with cancer?

Yes, certain cancers, such as lung cancer, breast cancer, and blood cancers, can cause hypercalcemia by increasing calcium release from bones or affecting kidney function.

Does hypercalcemia increase the risk of osteoporosis?

Yes, prolonged high calcium levels can weaken bones by increasing calcium resorption, leading to osteoporosis or fractures.

Is there a connection between hypercalcemia and high blood pressure?

Hypercalcemia can contribute to high blood pressure by affecting kidney function and vascular health.

Can hypercalcemia cause mood changes or confusion?

Yes, severe hypercalcemia can affect brain function, leading to confusion, memory problems, depression, or even hallucinations.

Is hypercalcemia a lifelong condition?

It depends on the cause. Some cases are temporary and resolve with treatment, while others may require ongoing management.

Can hypercalcemia return after treatment?

Yes, if the underlying cause is not fully addressed, hypercalcemia can recur. Regular monitoring and follow-up care are essential.

How often should calcium levels be checked if I’ve had hypercalcemia before?

Your doctor will determine the frequency based on your condition, but regular blood tests may be recommended to monitor calcium levels.

What is the long-term outlook for someone with hypercalcemia?

The prognosis depends on the severity and underlying cause. With proper treatment and lifestyle adjustments, most people can manage the condition effectively.

Reviewed By Dr. Priyamvada Tyagi, Consultant – Endocrinologist, Endocrinology & Diabetes on 18 March 2025.