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USMLE – Hypercalcemia

1. Abnormally high serum calcium
2. Malignancy related
3. Parathyroid related
4. Vitamin D
5. High bone turnover related
6. Renal failure related

Signs and Symptoms
1. Weakness and fatigue
2. Headaches
3. Constipation
4. Anorexia
5. Vomiting
6. Abdominal pain
7. Depression
8. Confusion and coma
9. Pruritus
10. Polyuria and polydipsia
11. Metastatic soft tissue calcification
12. Bone pain

Characteristic Test Findings
1. Decreased serum phosphorus
2. Increased serum gastrin
3. Abnormal levels of PTH (can be high or low, depending on cause)
4. Presence of parathormone-like substance (if caused by squamous cell carcinoma of lung)
5. Calciuria
6. Calcification of heart valves, lungs, and blood levels on plain films
7. EKG – shortened QT interval

Histology/Gross Pathology
Calcium deposition in renal tubules, blood vessels, and alveolar septa of lung

Associated Conditions
1. Pancreatitis
2. Peptic ulcer disease
3. Nephrolithiasis (kidney stones)
4. Nephrocalcinosis
5. Hypertension

Malignancy-related hypercalcemia caused by – 1) bone metastases 2) osteoclast activating factors 3) paraneoplastic release of parathormone-like substance

1. Hydration
2. Forced diuresis (furosemide)
3. Bisphosphonates such as pamidronate or zoledronate
4. Calcium (blocks bone resorption and increases urinary calcium excretion)
5. Mithramycin (largely replaced by biphosphonates)
6. Dialysis (in renal failure)
7. Glucocorticoids (especially in bone metastases and vitamin D intoxication)
8. Correction of underlying condition (stopping antacids or vitamin D intake)

Tips for the USMLE
1. Think moans, bones, stones, and groans (confusion, bone pain, kidney stones, abdominal pain) – this also applies to hyperparathyroidism
2. If question mentions a high serum calcium and a high serum PTH, think hyperparathyroidism

Lillian Thompson By Lillian Thompson

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