Skip to main content

Hypercalcemia

  • Chapter
  • First Online:
Endocrine Conditions in Pediatrics
  • 1197 Accesses

Abstract

Calcium, mostly stored in bone, is an essential nutrient involved in bone mineralization, muscle contraction, nerve conduction, and membrane voltage potential. Thus, abnormalities in calcium homeostasis can have multisystemic effects. Most hypercalcemia in the pediatric population is mild and identified incidentally with laboratory testing for other indications. Etiologies vary by age and can be classified as either parathyroid hormone (PTH)-independent or PTH-dependent, and genetic or acquired. Once the diagnosis of hypercalcemia is confirmed, the patient should be referred to a pediatric endocrinologist for further evaluation and management. Severe or symptomatic hypercalcemia requires hospitalization with treatment to relieve symptoms, prevent complications, and address the underlying etiology.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ghosh AK, Joshi SR. Disorders of calcium, phosphorus and magnesium metabolism. J Assoc Physicians India. 2008;56:613–21.

    PubMed  Google Scholar 

  2. Lietman SA, Germain-Lee EL, Levine MA. Hypercalcemia in children and adolescents. Curr Opin Pediatr. 2010;22(4):508–15. https://doi.org/10.1097/MOP.0b013e32833b7c23.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Stokes VJ, Nielsen MF, Hannan FM, Thakker RV. Hypercalcemic disorders in children. J Bone Miner Res. 2017;32(11):2157–70. https://doi.org/10.1002/jbmr.3296.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bushinsky DA, quintet MRDE. calcium. Lancet. 1998;352(9124):306–11.

    Article  CAS  Google Scholar 

  5. Auron A, Alon US. Hypercalcemia: a consultant's approach. Pediatr Nephrol. 2018;33(9):1475–88. https://doi.org/10.1007/s00467-017-3788-z. Epub 2017 Sep 6.

    Article  PubMed  Google Scholar 

  6. McNeilly JD, Boal R, Shaikh MG, Ahmed SF. Frequency and aetiology of hypercalcaemia. Arch Dis Child. 2016;101(4):344–7. https://doi.org/10.1136/archdischild-2015-309029. Epub 2016 Feb 22.

    Article  CAS  PubMed  Google Scholar 

  7. Clarkson MR, Magee CN, Brenner BM. Mineral bone disease in chronic kidney disease. In: Brenner BM, editor. Pocket companion to Brenner and rector’s the kidney. Philadelphia: Elsevier; 2010. p. 616–36.

    Google Scholar 

  8. Moe SM. Disorders involving calcium, phosphorus, and magnesium. Prim Care. 2008;35(2):215–vi. https://doi.org/10.1016/j.pop.2008.01.007.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Vaidya SR, Aeddula NR. Nephrocalcinosis. [Updated 2019 Jan 7]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2019.

    Google Scholar 

  10. Davies JH, Shaw NJ. Investigation and management of hypercalcaemia in children. Arch Dis Child. 2012;97(6):533–8. https://doi.org/10.1136/archdischild-2011-301284. Epub 2012 Mar 23.

    Article  PubMed  Google Scholar 

  11. Stewart AF. Hyperparathyroidism, humoral hypercalcemia of malignancy, and the anabolic actions of parathyroid hormone and parathyroid hormone-related protein on the skeleton. J Bone Miner Res. 2002;17:758.

    Article  Google Scholar 

  12. Misiorowski W, Czajka-Oraniec I, Kochman M, Zgliczyński W, Bilezikian JP. Osteitis fibrosa cystica-a forgotten radiological feature of primary hyperparathyroidism. Endocrine. 2017;58(2):380–5. https://doi.org/10.1007/s12020-017-1414-2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Chang WT, Radin B, McCurdy MT. Calcium, magnesium, and phosphate abnormalities in the emergency department. Emerg Med Clin North Am. 2014;32(2):349–66. https://doi.org/10.1016/j.emc.2013.12.006. Epub 2014 Feb 19.

    Article  PubMed  Google Scholar 

  14. Barreras RF, Donaldson RM Jr. Role of calcium in gastric hypersecretion, parathyroid adenoma and peptic ulcer. N Engl J Med. 1967;276(20):1122–4. https://doi.org/10.1056/NEJM196705182762005.

    Article  CAS  PubMed  Google Scholar 

  15. Ragno A, et al. Chronic constipation in hypercalcemic patients with primary hyperparathyroidism. Eur Rev Med Pharmacol Sci. 2012;16(7):884–9.

    CAS  PubMed  Google Scholar 

  16. Karpati G, Frame B. Neuropsychiatric disorders in primary hyperparathyroidism. Arch Neurol. 1964;10:387–97. https://doi.org/10.1001/archneur.1964.00460160057005.

    Article  CAS  PubMed  Google Scholar 

  17. Brown SJ, Ruppe MD, Tabatabai LS. The parathyroid gland and heart disease. Methodist Debakey Cardiovasc J. 2017;13(2):49–54. https://doi.org/10.14797/mdcj-13-2-49.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Walker MD, Silverberg SJ. Cardiovascular aspects of primary hyperparathyroidism. J Endocrinol Invest. 2008;31(10):925–31. https://doi.org/10.1007/BF03346443.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Abu Raya B, et al. Transient hypercalcemia in preterm infants: insights into natural history and laboratory evaluation. Glob Pediatr Health. 2014;1:2333794X14560818. . Published 2014 Nov 21. https://doi.org/10.1177/2333794X14560818.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hak EB, et al. Increased parathyroid hormone and decreased calcitriol during neonatal extracorporeal membrane oxygenation. Intensive Care Med. 2005;31(2):264–70. Epub 2005 Feb 1.

    Article  Google Scholar 

  21. Rodd C, Goodyer P. Hypercalcemia of the newborn: etiology, evaluation, and management. Pediatr Nephrol. 1999;13(6):542–7. https://doi.org/10.1007/s004670050654.

    Article  CAS  PubMed  Google Scholar 

  22. Baker SS, et al. American Academy of Pediatrics Committee on Nutrition: calcium requirements of infants, children, and adolescents. Pediatrics. 1999;104(5 Pt 1):1152–7.

    CAS  PubMed  Google Scholar 

  23. Jacobus CH, et al. Hypervitaminosis D associated with drinking milk. N Engl J Med. 1992;326(18):1173–7.

    Article  CAS  Google Scholar 

  24. Conaway HH, Henning P, Lerner UH. Vitamin a metabolism, action, and role in skeletal homeostasis. Endocr Rev. 2013;34(6):766–97. https://doi.org/10.1210/er.2012-1071. Epub 2013 May 29.

    Article  CAS  PubMed  Google Scholar 

  25. Farooque A, et al. Expression of 25-hydroxyvitamin D3-1alpha-hydroxylase in subcutaneous fat necrosis. Br J Dermatol. 2009;160(2):423–5. https://doi.org/10.1111/j.1365-2133.2008.08844.x.

    Article  CAS  PubMed  Google Scholar 

  26. Kruse K, Irle U, Uhlig R. Elevated 1,25-dihydroxyvitamin D serum concentrations in infants with subcutaneous fat necrosis. J Pediatr. 1993;122(3):460–3. https://doi.org/10.1016/s0022-3476(05)83441-9.

    Article  CAS  PubMed  Google Scholar 

  27. Felsenfeld AJ, Levine BS. Milk alkali syndrome and the dynamics of calcium homeostasis. Clin J Am Soc Nephrol. 2006;1(4):641–54. Epub 2006 Apr 26.

    Article  CAS  Google Scholar 

  28. Goltzman D, et al. Approach to hypercalcemia. South Dartmouth, MA: MDText.com, Inc.; 2019.

    Google Scholar 

  29. Kimura S, et al. A case of pheochromocytoma producing parathyroid hormone-related protein and presenting with hypercalcemia. Clin Endocrinol Metab. 1990;70(6):1559–63.

    Article  CAS  Google Scholar 

  30. Lagishetty V, et al. 1alpha-hydroxylase and innate immune responses to 25-hydroxyvitamin D in colonic cell lines. J Steroid Biochem Mol Biol. 2010;121(1–2):228–33. https://doi.org/10.1016/j.jsbmb.2010.02.004.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Whyte MP. Hypophosphatasia: an overview for 2017. Bone. 2017;102:15–25. https://doi.org/10.1016/j.bone.2017.02.011. Epub 2017 Feb 24.

    Article  CAS  PubMed  Google Scholar 

  32. American Academy of Pediatrics Committee on Genetics. Health care supervision for children with Williams syndrome. Pediatrics. 2001;107(5):1192–204.

    Google Scholar 

  33. Distelmaier F, et al. Blue diaper syndrome and PCSK1 mutations. Pediatrics. 2018;141(Suppl 5):S501–5. https://doi.org/10.1542/peds.2017-0548.

    Article  PubMed  Google Scholar 

  34. Saarela T, Similä S, Koivisto M. Hypercalcemia and nephrocalcinosis in patients with congenital lactase deficiency. J Pediatr. 1995;127(6):920–3.

    Article  CAS  Google Scholar 

  35. Wongsaengsak S, et al. A novel SLC12A1 gene mutation associated with hyperparathyroidism, hypercalcemia, nephrogenic diabetes insipidus, and nephrocalcinosis in four patients. Bone. 2017;97:121–5. https://doi.org/10.1016/j.bone.2017.01.011. Epub 2017 Jan 14.

    Article  CAS  PubMed  Google Scholar 

  36. Bennett J, Schrier Vergano SA, Deardorff MA. IMAGe syndrome. In: Adam MP, Ardinger HH, Pagon RA, et al., editors. GeneReviews. Seattle: University of Washington; 1993–2019.

    Google Scholar 

  37. Saito H, et al. Progression of mineral ion abnormalities in patients with Jansen metaphyseal chondrodysplasia. J Clin Endocrinol Metab. 2018;103(7):2660–9. https://doi.org/10.1210/jc.2018-00332.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Glass EJ, Barr DG. Transient neonatal hyperparathyroidism secondary to maternal pseudohypoparathyroidism. Arch Dis Child. 1981;56(7):565–8. https://doi.org/10.1136/adc.56.7.565.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Cole DE, et al. Neonatal severe hyperparathyroidism, secondary hyperparathyroidism, and familial hypocalciuric hypercalcemia: multiple different phenotypes associated with an inactivating Alu insertion mutation of the calcium-sensing receptor gene. Am J Med Genet. 1997;71(2):202–10.

    Article  CAS  Google Scholar 

  40. Huang CB, et al. Primary hyperparathyroidism in children: report of a case and a brief review of the literature. J Formos Med Assoc. 1993;92(12):1095–8.

    CAS  PubMed  Google Scholar 

  41. Wasserman JD, Tomlinson GE, Druker H, et al. Multiple endocrine neoplasia and hyperparathyroid-jaw tumor syndromes: clinical features, genetics, and surveillance recommendations in childhood. Clin Cancer Res. 2017;23(13):e123–32. https://doi.org/10.1158/1078-0432.CCR-17-0548.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Kollars J, et al. Primary hyperparathyroidism in pediatric patients. Pediatrics. 2005;115(4):974–80.

    Article  Google Scholar 

  43. Multiple endocrine neoplasia. Lister Hill National Center for Biomedical Communications U.S. National Library of Medicine National Institutes of Health Department of Health & Human Services. https://ghr.nlm.nih.gov/condition/multiple-endocrine-neoplasia. Published December 10, 2019. Accessed December 20, 2019.

  44. Mancilla E, Levine M. Hypocalcemia, hypercalcemia, and hypercalciuria. In: TK MI, American Academy of Pediatrics, editors. American Academy of Pediatrics Textbook of Pediatric Care. 2nd ed. Elk Grove Village: American Academy of Pediatrics; 2017. p. 2170–9.

    Google Scholar 

  45. Mogas E, et al. Successful use of cinacalcet to treat parathyroid-related hypercalcemia in two pediatric patients. Endocrinol Diabetes Metab Case Rep. 2018;2018:18–0009. . Published 2018 Jun 6. https://doi.org/10.1530/EDM-18-0009.

    Article  PubMed Central  Google Scholar 

  46. Fisher MM, Cabrera SM, Imel EA. Successful treatment of neonatal severe hyperparathyroidism with cinacalcet in two patients. Endocrinol Diabetes Metab Case Rep. 2015;2015:150040. https://doi.org/10.1530/EDM-15-0040.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lisa Swartz Topor .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Chin, A., Topor, L.S. (2021). Hypercalcemia. In: Stanley, T., Misra, M. (eds) Endocrine Conditions in Pediatrics. Springer, Cham. https://doi.org/10.1007/978-3-030-52215-5_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-52215-5_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-52214-8

  • Online ISBN: 978-3-030-52215-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics