Hypercalcemia: overview

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Sections available in full article Introduction, Presenting signs, Age predisposition, Breed predisposition, Pathogenesis, Etiology, Pathophysiology, Timecourse (incubation, duration), Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Gross autopsy findings, Differential diagnosis, Treatment, Initial symptomatic treatment, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Dr Philip K Nicholls BVSc BSc PhD MRCVS FRCPath
Dr Marion O'Leary BSc BVMS PhD DipRCPath MRCVS

Introduction

  • Persistently raised serum calcium.
  • Cause : multiple causes including neoplasia, renal failure, granulomatous disease, hypoadrenocorticism, hypervitaminosis D and others.
  • Diagnosis : serum biochemistry defines the syndrome, but other tests may be required to identify the underlying cause.
  • Signs : may include anorexia, lethargy, weight loss, sometimes polyuria/polydipsia, and other signs dependant upon cause.
  • Treatment : fluid therapy, frusemide diuresis, glucocorticoids, or surgery (e.g. for parathyroid neoplasms).
  • Prognosis : variable according to cause, but persistent untreated hypercalcemia may lead to renal failure and organ mineralization.

Diagnosis

Clinical signs

  • Hypercalcemia itself causes various signs:
    • Polyuria/polydipsia, +/- dehydration (from direct effects of calcium on renal function of from renal mineralization).
    • Weakness, lethargy, cardiac dysrhythmias (from reduced membrane excitability).
    • Also gastrointestinal signs such as vomition and/or constipation.
  • Underlying diseases may be associated with other signs such as:
    • Enlarged lymph nodes (lymphoma)  Lymphoma  .
    • Palpable cervical mass (parathyroid tumor).
    • Irregular renal outline or renal pain (chronic renal failure).
    • Bone pain or pathological fracture (bone neoplasia  Bone tumor: overview   or infection).
    • Mass lesion (neoplasm or granuloma).
    • Dysuria  Dysuria investigation   (calcium oxalate urolithiasis)

Diagnosis

Differential diagnosis

Other causes of polyuria/polydipsia.

  • Renal failure  Kidney: chronic kidney disease  ,  Kidney: acute renal failure  .
  • Liver disease.
  • Diabetes mellitus  Diabetes mellitus  .

Other causes of weakness/lethargy

  • Cardiac disease.
  • Hypoadrenocorticism  Hypoadrenocorticism  .
  • Anemia.

Sequelae

Prognosis

  • Varies according to underlying disease.
  • Paraneoplastic hypercalcemia has poorer prognosis.
  • Surgical removal of parathyroid tumors has shown an excellent prognosis.
  • Rodenticide intoxication has variable prognosis dependant upon dose absorbed and delay before therapy.
  • Prognosis may be poor if hypercalcemia has resulted in soft tissue mineralization of lungs and/or kidneys.

Expected response to treatment

  • Correction of hypercalcemia should result in improvement of directly related signs such as dehydration, azotemia, cardiac arrhythmia, and weakness.
  • Other responses depend upon the underlying cause and the specific therapy initiated.

Reasons for treatment failure

  • Non-resolvable neoplasia (in humoral hypercalcemia of malignancy).
  • Soft-tissue mineralization in lungs and kidney causing respiratory failure or renal failure.

Sources

Publications

Refereed papers

  • Bolliger APet al(2002)Detection of parathyroid hormone-related protein in cats with humoral hypercalcemia of malignancy.Vet Clin Pathol31(1), 3-8.PubMed
  • Smith SA, Freeman LC, & Bagladi-Swanson M (2002)Hypercalcemia due to latrogenic secondary hypoadrenocorticism and diabetes mellitus in a cat.J Am Anim Hosp Assoc.38(1), 41-44.PubMed
  • Midkiff AMet al(2000)Idiopathic hypercalcemia in cats.J Vet Intern Med14(6) 619-626.PubMed
  • Sueda MT & Stefanacci JD (2000)Ultrasound evaluation of the parathyroid glands in two hypercalcemic cats.Vet Radiol Ultrasound41(5) 448-451.PubMed
  • Savary KC, Price GS & Vaden SL (2000)Hypercalcemia in cats: a retrospective study of 71 cases (1991-1997).J Vet Intern Med14(2) 184-189.PubMed
  • Anderson TE, Legendre AM & McEntree MM (2000)Probable hypercalcemia of malignancy in a cat with bronchogenic adenocarcinoma. J Am Anim Hosp Assoc36(1) 52-5.
  • Mealey KL et al(1999)Hypercalcemia associated with granulomatous disease in a cat.J Am Vet Med Assoc215(7) 959-962.PubMed
  • McClain HM, Barsanti JA & Bartges JW (1999)Hypercalcemia and calcium oxalate urolithiasis in cats: a report of five cases.J Am Anim Hosp Assoc35(4), 297-301.PubMed
  • Kallet AJet al(1991)Primary hyperparathyroidism in cats: seven cases (1984-1989).J Am Vet Med Assoc199(12), 1767-1771.PubMed

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