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.
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References
Ghosh AK, Joshi SR. Disorders of calcium, phosphorus and magnesium metabolism. J Assoc Physicians India. 2008;56:613–21.
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.
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.
Bushinsky DA, quintet MRDE. calcium. Lancet. 1998;352(9124):306–11.
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.
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.
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.
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.
Vaidya SR, Aeddula NR. Nephrocalcinosis. [Updated 2019 Jan 7]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2019.
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.
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.
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.
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.
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.
Ragno A, et al. Chronic constipation in hypercalcemic patients with primary hyperparathyroidism. Eur Rev Med Pharmacol Sci. 2012;16(7):884–9.
Karpati G, Frame B. Neuropsychiatric disorders in primary hyperparathyroidism. Arch Neurol. 1964;10:387–97. https://doi.org/10.1001/archneur.1964.00460160057005.
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.
Walker MD, Silverberg SJ. Cardiovascular aspects of primary hyperparathyroidism. J Endocrinol Invest. 2008;31(10):925–31. https://doi.org/10.1007/BF03346443.
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.
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.
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.
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.
Jacobus CH, et al. Hypervitaminosis D associated with drinking milk. N Engl J Med. 1992;326(18):1173–7.
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.
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.
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.
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.
Goltzman D, et al. Approach to hypercalcemia. South Dartmouth, MA: MDText.com, Inc.; 2019.
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.
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.
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.
American Academy of Pediatrics Committee on Genetics. Health care supervision for children with Williams syndrome. Pediatrics. 2001;107(5):1192–204.
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.
Saarela T, Similä S, Koivisto M. Hypercalcemia and nephrocalcinosis in patients with congenital lactase deficiency. J Pediatr. 1995;127(6):920–3.
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.
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.
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.
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.
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.
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.
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.
Kollars J, et al. Primary hyperparathyroidism in pediatric patients. Pediatrics. 2005;115(4):974–80.
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.
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.
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.
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.
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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
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DOI: https://doi.org/10.1007/978-3-030-52215-5_6
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