Hypercalcemia causes: Difference between revisions

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==Overview==
==Overview==
Hypercalcemia is most commonly caused by hyperparathyroisism and malignancy. Other causes of hypercalcemia include hyperthyroidism, vitamin D toxicity, increased calcium intake, granulomatous diseases ( such sarcoidosis), and various renal disorders.
Hypercalcemia is most commonly caused by [[hyperparathyroidism]] and [[malignancy]]. Other causes of hypercalcemia include [[hyperthyroidism]], [[Hypervitaminosis D|vitamin D toxicity]], increased calcium intake, granulomatous diseases ( such [[sarcoidosis]]), and various renal disorders.


==Causes==
==Causes==
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===Common Causes===
===Common Causes===
*[[Hyperparathyroidism]]<ref name="pmid20614300">{{cite journal |vauthors=Wieneke JA, Smith A |title=Parathyroid adenoma |journal=Head Neck Pathol |volume=2 |issue=4 |pages=305–8 |year=2008 |pmid=20614300 |pmc=2807581 |doi=10.1007/s12105-008-0088-8 |url=}}</ref>
Common causes of hypercalcemia include:<ref name="pmid23148166">{{cite journal| author=Carroll R, Matfin G| title=Endocrine and metabolic emergencies: hypercalcaemia. | journal=Ther Adv Endocrinol Metab | year= 2010 | volume= 1 | issue= 5 | pages= 225-34 | pmid=23148166 | doi=10.1177/2042018810390260 | pmc=3474617 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23148166  }} </ref>
*[[Hyperparathyroidism]]<ref name="pmid12412783">{{cite journal |vauthors=Peacock M |title=Primary hyperparathyroidism and the kidney: biochemical and clinical spectrum |journal=J. Bone Miner. Res. |volume=17 Suppl 2 |issue= |pages=N87–94 |year=2002 |pmid=12412783 |doi= |url=}}</ref><ref name="pmid2763869">{{cite journal |vauthors=Silverberg SJ, Shane E, de la Cruz L, Dempster DW, Feldman F, Seldin D, Jacobs TP, Siris ES, Cafferty M, Parisien MV |title=Skeletal disease in primary hyperparathyroidism |journal=J. Bone Miner. Res. |volume=4 |issue=3 |pages=283–91 |year=1989 |pmid=2763869 |doi=10.1002/jbmr.5650040302 |url=}}</ref>
**Primary hyperparathyroidism
**Primary hyperparathyroidism
***Parathyroid adenoma
***Parathyroid adenoma<ref name="pmid20614300">{{cite journal |vauthors=Wieneke JA, Smith A |title=Parathyroid adenoma |journal=Head Neck Pathol |volume=2 |issue=4 |pages=305–8 |year=2008 |pmid=20614300 |pmc=2807581 |doi=10.1007/s12105-008-0088-8 |url=}}</ref>
***Parathyroid hyperplasia
***Parathyroid hyperplasia
***Parathyroid carcinoma
***Parathyroid carcinoma
**Secondary hyperparathyroidism (long standing)
**Secondary hyperparathyroidism (long standing)<ref name="pmid15507543">{{cite journal| author=Rodriguez M, Nemeth E, Martin D| title=The calcium-sensing receptor: a key factor in the pathogenesis of secondary hyperparathyroidism. | journal=Am J Physiol Renal Physiol | year= 2005 | volume= 288 | issue= 2 | pages= F253-64 | pmid=15507543 | doi=10.1152/ajprenal.00302.2004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15507543  }} </ref>
**Tertiary hyperparathyroidism
**Tertiary hyperparathyroidism<ref name="pmid9780988">{{cite journal |vauthors=Kilgo MS, Pirsch JD, Warner TF, Starling JR |title=Tertiary hyperparathyroidism after renal transplantation: surgical strategy |journal=Surgery |volume=124 |issue=4 |pages=677–83; discussion 683–4 |year=1998 |pmid=9780988 |doi=10.1067/msy.1998.91483 |url=}}</ref>
**Neonatal severe hyperparathyroidism
**Neonatal severe hyperparathyroidism
*[[Hypercalcemia]] of [[malignancy]]
*[[Hypercalcemia]] of [[malignancy]]<ref name="pmid26713296">{{cite journal |vauthors=Mirrakhimov AE |title=Hypercalcemia of Malignancy: An Update on Pathogenesis and Management |journal=N Am J Med Sci |volume=7 |issue=11 |pages=483–93 |year=2015 |pmid=26713296 |pmc=4683803 |doi=10.4103/1947-2714.170600 |url=}}</ref><ref name="pmid15673803">{{cite journal| author=Stewart AF| title=Clinical practice. Hypercalcemia associated with cancer. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 4 | pages= 373-9 | pmid=15673803 | doi=10.1056/NEJMcp042806 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15673803  }} </ref>
*[[Hyperthyroidism]]
*[[Hyperthyroidism]]<ref name="pmid937877">{{cite journal| author=Burman KD, Monchik JM, Earll JM, Wartofsky L| title=Ionized and total serum calcium and parathyroid hormone in hyperthyroidism. | journal=Ann Intern Med | year= 1976 | volume= 84 | issue= 6 | pages= 668-71 | pmid=937877 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=937877  }} </ref><ref name="pmid14715479">{{cite journal| author=Iqbal AA, Burgess EH, Gallina DL, Nanes MS, Cook CB| title=Hypercalcemia in hyperthyroidism: patterns of serum calcium, parathyroid hormone, and 1,25-dihydroxyvitamin D3 levels during management of thyrotoxicosis. | journal=Endocr Pract | year= 2003 | volume= 9 | issue= 6 | pages= 517-21 | pmid=14715479 | doi=10.4158/EP.9.6.517 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14715479  }} </ref>
*Hypervitaminosis D
*Hypervitaminosis D<ref name="pmid8120527">{{cite journal |vauthors=Hoeck HC, Laurberg G, Laurberg P |title=Hypercalcaemic crisis after excessive topical use of a vitamin D derivative |journal=J. Intern. Med. |volume=235 |issue=3 |pages=281–2 |year=1994 |pmid=8120527 |doi= |url=}}</ref><ref name="pmid1313547">{{cite journal |vauthors=Jacobus CH, Holick MF, Shao Q, Chen TC, Holm IA, Kolodny JM, Fuleihan GE, Seely EW |title=Hypervitaminosis D associated with drinking milk |journal=N. Engl. J. Med. |volume=326 |issue=18 |pages=1173–7 |year=1992 |pmid=1313547 |doi=10.1056/NEJM199204303261801 |url=}}</ref><ref name="pmid8620732">{{cite journal| author=Sharma OP| title=Vitamin D, calcium, and sarcoidosis. | journal=Chest | year= 1996 | volume= 109 | issue= 2 | pages= 535-9 | pmid=8620732 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8620732  }}</ref>
*Increased calcium intake
*Chronic kidney disease<ref name="pmid2239937">{{cite journal| author=Meric F, Yap P, Bia MJ| title=Etiology of hypercalcemia in hemodialysis patients on calcium carbonate therapy. | journal=Am J Kidney Dis | year= 1990 | volume= 16 | issue= 5 | pages= 459-64 | pmid=2239937 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2239937  }} </ref>
*Chronic kidney disease
*Milk-alkali syndrome
*Milk-alkali syndrome
*[[Hypokalaemic distal renal tubular acidosis]]
*[[Hypokalaemic distal renal tubular acidosis]]
*[[Sarcoidosis]]
*[[Sarcoidosis]]<ref name="pmid9215298">{{cite journal |vauthors=Dusso AS, Kamimura S, Gallieni M, Zhong M, Negrea L, Shapiro S, Slatopolsky E |title=gamma-Interferon-induced resistance to 1,25-(OH)2 D3 in human monocytes and macrophages: a mechanism for the hypercalcemia of various granulomatoses |journal=J. Clin. Endocrinol. Metab. |volume=82 |issue=7 |pages=2222–32 |year=1997 |pmid=9215298 |doi=10.1210/jcem.82.7.4074 |url=}}</ref><ref name="pmid22412034">{{cite journal| author=Vanstone MB, Oberfield SE, Shader L, Ardeshirpour L, Carpenter TO| title=Hypercalcemia in children receiving pharmacologic doses of vitamin D. | journal=Pediatrics | year= 2012 | volume= 129 | issue= 4 | pages= e1060-3 | pmid=22412034 | doi=10.1542/peds.2011-1663 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22412034  }}</ref>
*Post renal transplantation
*Post renal transplantation


=== Less Common Cause ===
=== Less Common Cause ===
Less common causes of hypercalcemia include:<ref name="pmid23148166">{{cite journal| author=Carroll R, Matfin G| title=Endocrine and metabolic emergencies: hypercalcaemia. | journal=Ther Adv Endocrinol Metab | year= 2010 | volume= 1 | issue= 5 | pages= 225-34 | pmid=23148166 | doi=10.1177/2042018810390260 | pmc=3474617 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23148166  }} </ref>
* Immobilization
* Immobilization
* Pagets disease of bone
* Pagets disease of bone
* Hypervitaminosis A
* Hypervitaminosis A
* [[Lithium]]
* Pheochromocytoma
* Pheochromocytome
* Adrenal insufficiency
* Adrenal insufficiency
* Rhabdomyolysis
* Rhabdomyolysis
* Acute renal failure
* Acute renal failure
* Theophylline toxicity
* Familial hypocalciuric hypercalcemia<ref name="pmid26963950">{{cite journal| author=Vargas-Poussou R, Mansour-Hendili L, Baron S, Bertocchio JP, Travers C, Simian C et al.| title=Familial Hypocalciuric Hypercalcemia Types 1 and 3 and Primary Hyperparathyroidism: Similarities and Differences. | journal=J Clin Endocrinol Metab | year= 2016 | volume= 101 | issue= 5 | pages= 2185-95 | pmid=26963950 | doi=10.1210/jc.2015-3442 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26963950  }}</ref>
* Familial hypocalciuric hypercalcemia
* Methphysial chondrodysplasia
* Methphysial chondrodysplasia
* Conenital lactase deficienccy
* Conenital lactase deficienccy
* [[Teriparatide]]
*[[Thiazide]]
* Estrogen
*Idiopathic infantile hypercalcemia (Williams syndrome)
*Idiopathic infantile hypercalcemia (Williams syndrome)
*Mutations of the calcium-sensing receptor
*Mutations of the calcium-sensing receptor
*Subcutaneous fat necrosis
*Subcutaneous fat necrosis
*[[Cidofovir]]
*[[Danazol]]
*[[Dexlansoprazole]]
*Blue diaper syndrome
*Blue diaper syndrome
*[[Fluoxymesterone]]
*[[Gestrinone]]
*[[Hypophosphataemia]]
*[[Hypophosphataemia]]
*[[Hypophosphatasia ]]
*[[Hypophosphatasia ]]
* [[Nandrolone]]
*[[Paricalcitol]]
* [[Tamoxifen]]
* [[Toremifene]]
*Dietary phosphate deficiency
*Dietary phosphate deficiency
*Medication-induced
**[[Lithium]]<ref name="pmid2918061">{{cite journal |vauthors=Mallette LE, Khouri K, Zengotita H, Hollis BW, Malini S |title=Lithium treatment increases intact and midregion parathyroid hormone and parathyroid volume |journal=J. Clin. Endocrinol. Metab. |volume=68 |issue=3 |pages=654–60 |year=1989 |pmid=2918061 |doi=10.1210/jcem-68-3-654 |url=}}</ref>
**[[Thiazide]]<ref name="pmid26751196">{{cite journal| author=Griebeler ML, Kearns AE, Ryu E, Thapa P, Hathcock MA, Melton LJ et al.| title=Thiazide-Associated Hypercalcemia: Incidence and Association With Primary Hyperparathyroidism Over Two Decades. | journal=J Clin Endocrinol Metab | year= 2016 | volume= 101 | issue= 3 | pages= 1166-73 | pmid=26751196 | doi=10.1210/jc.2015-3964 | pmc=4803175 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26751196  }}</ref>
**Theophylline toxicity
**[[Teriparatide]]
** Estrogen
** [[Cidofovir]]
**[[Danazol]]
**[[Dexlansoprazole]]
**[[Fluoxymesterone]]
**[[Gestrinone]]
**[[Nandrolone]]
**[[Paricalcitol]]
** [[Tamoxifen]]
** [[Toremifene]]


===Causes by Organ System===
===Causes by Organ System===
{| style="width:80%; height:100px" border="1"
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" | [[Beuren-williams syndrome]], [[Vasoactive intestinal polypeptide-producing tumor]]
| style="width:75%" bgcolor="Beige" ; border="1" | [[Beuren-Williams syndrome]], [[Vasoactive intestinal polypeptide-producing tumor]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| '''Chemical / poisoning'''
| bgcolor="Beige" | [[Aluminium antacid overuse]], [[Aluminum intoxication]], [[Calcium acetate]], [[Caspofungin acetate]], [[Cefepime]], [[Chlortalidone]], [[Theophylline toxicity]]
| bgcolor="Beige" | Aluminium antacid overuse, Aluminum intoxication, [[Calcium acetate]], [[Caspofungin acetate]], [[Cefepime]], [[Chlortalidone]], [[Theophylline|Theophylline toxicity]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| '''Dermatologic'''
| bgcolor="Beige" | [[Leprosy]], [[Subcutaneous fat necrosis of newborn]]
| bgcolor="Beige" | [[Leprosy]], Subcutaneous fat necrosis of newborn
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
| bgcolor="Beige" | [[Cidofovir]], [[Danazol]], [[Dexlansoprazole]], [[Diuretics]], [[Fluoxymesterone]], [[Gestrinone]], [[Lithium]], [[Nandrolone]], [[Paricalcitol]], [[Tamoxifen]], [[Teriparatide]], [[Thiazide]], [[Toremifene]]
| bgcolor="Beige" | [[Cidofovir]], [[Danazol]], [[Dexlansoprazole]], [[Diuretics]], [[Fluoxymesterone]], [[Gestrinone]], [[Lithium]], [[Nandrolone]], [[Paricalcitol]], [[Tamoxifen]], [[Teriparatide]], [[Thiazide]], [[Toremifene]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
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|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
| bgcolor="Beige" | [[Abnormal parathyroid gland function]], [[Acromegaly]], [[Addison's disease]], [[Adenoma]], [[Adrenal cortex insufficiency]], [[Adrenal insufficiency]], [[Adult t-cell lymphoma ]] , [[Bartter's syndrome]], [[Cushing's syndrome]], [[Familial hypocalcuric hypercalcemia]], [[Familial isolated hyperparathyroidism]], [[Growth hormone secreting pituitary adenoma]], [[Hypercalcemia of malignancy]],  [[Hyperparathyroidism ]] , [[Hyperthyroidism]], [[Hypoparathyroidism]], [[Multiple endocrine neoplasia]], [[Neonatal severe primary hyperparathyroidism]], [[Non-parathyroid mediated]],  [[Paget's disease of bone]], [[Parathyroid carcinoma]], [[Parathyroid hormone related peptide]], [[Parathyroid hyperplasia]], [[Parathyroid mediated]],  [[Pituitary tumour ]] , [[Pthrp]],  [[Tryptophan malabsorption syndrome]]
| bgcolor="Beige" | Abnormal parathyroid gland function, [[Acromegaly]], [[Addison's disease]], [[Adenoma]], [[Adrenal cortex insufficiency]], [[Adrenal insufficiency]], [[Adult T-cell leukemia]], [[Bartter's syndrome]], [[Cushing's syndrome]], [[Familial hypocalciuric hypercalcemia]], [[Hyperparathyroidism|Familial isolated hyperparathyroidism]], [[Growth hormone secreting pituitary adenoma|Growth hormone-secreting pituitary adenoma]], Hypercalcemia of malignancy,  [[Hyperparathyroidism]] , [[Hyperthyroidism]], [[Multiple endocrine neoplasia]], [[Hyperparathyroidism|Neonatal severe primary hyperparathyroidism]], [[Paget's disease of bone]], [[Parathyroid adenoma]], [[Parathyroid cancer|Parathyroid carcinoma]], Parathyroid hormone-related peptide, Parathyroid hyperplasia, [[Pituitary tumor|Pituitary tumour]], Tryptophan malabsorption syndrome
|-  
|-  
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
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|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
| bgcolor="Beige" | [[Hepatocellular carcinoma]], [[Vipoma]]
| bgcolor="Beige" | [[Hepatocellular carcinoma]], [[Vipoma]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
| bgcolor="Beige" | [[Activation of extrarenal 1 alpha-hydroxylase ]] , [[Beuren-williams syndrome]], [[Familial isolated hyperparathyroidism]],  [[Inherited variants]],  [[Metaphyseal chondrodysplasia]], [[Phosphoethanolaminuria]], [[Pseudophosphatasia ]] , [[William's syndrome]]
| bgcolor="Beige" | Activation of extra-renal 1 alpha-hydroxylase, [[Beuren-Williams syndrome]], [[Familial isolated hyperparathyroidism]],  Metaphyseal chondrodysplasia, Phosphoethanolaminuria, Pseudophosphatasia, [[William's syndrome]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
| bgcolor="Beige" | [[Acute adult t-cell leukemia ]] , [[Adult t-cell leukemia]], [[Chronic adult t-cell leukemia ]] , [[Cuffed blood sample]], [[Cushing's syndrome]], [[Familial hypocalcuric hypercalcemia]], [[Hematologic malignancy]], [[Hodgkin's lymphoma]], [[Hypervitaminosis a]], [[Hypervitaminosis d]], [[Hypokalaemic distal renal tubular acidosis]], [[Hypophosphataemia]], [[Hypophosphatasia ]] , [[Leukemia]], [[Lymphoma]], [[Multiple myeloma]], [[Plasma cell granuloma]], [[Polycythemia]], [[Pseudophosphatasia ]] ,  [[Pthrp]],  [[Smoldering adult t-cell leukemia ]]
| bgcolor="Beige" | [[Acute adult T-cell leukemia]], [[Adult T-cell leukemia]], [[Chronic adult T-cell leukemia]], Cuffed blood sample, [[Cushing's syndrome]], [[Familial hypocalciuric hypercalcemia]], [[Hematologic malignancy]], [[Hodgkin's lymphoma]], [[Hypervitaminosis A]], [[Hypervitaminosis D]], [[Hypokalaemic distal renal tubular acidosis]], [[Hypophosphataemia]], [[Hypophosphatasia]], [[Leukemia]], [[Lymphoma]], [[Multiple myeloma]], Plasma cell granuloma, [[Polycythemia]], Pseudophosphatasia, [[Adult T-cell leukemia|Smoldering adult T-cell leukemia]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
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|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
| bgcolor="Beige" | [[Coccidioidomycosis]], [[Histoplasmosis]], [[Mycobacterium tuberculosis]],  [[Oral candidiasis]], [[Tuberculosis]]
| bgcolor="Beige" | [[Coccidioidomycosis]], [[Histoplasmosis]], [[Oral candidiasis]], [[Tuberculosis]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
| '''Musculoskeletal / Ortho'''
| bgcolor="Beige" | [[Bone cancer]], [[Bone fracture]], [[Immobilization]], [[Osteolytic bone metastases and local cytokines]], [[Osteomalacia]], [[Osteoporosis]], [[Paget's disease of bone]], [[Paraplegia]]
| bgcolor="Beige" | [[Bone cancer]], [[Bone fracture]], Immobilization, Osteolytic bone metastases and local cytokines, [[Osteomalacia]], [[Osteoporosis]], [[Paget's disease of bone]], [[Paraplegia]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
| bgcolor="Beige" | [[Adrenal cortex insufficiency]], [[Brown-sequard syndrome ]]
| bgcolor="Beige" | [[Adrenal cortex insufficiency]], [[Brown-Sequard syndrome]] 
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| '''Nutritional / Metabolic'''
| bgcolor="Beige" | [[Milk-alkali syndrome]], [[Parenteral nutrition]]
| bgcolor="Beige" | [[Milk-alkali syndrome]], [[Parenteral nutrition]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
| bgcolor="Beige" | [[Breast cancer]], [[Ovarian cancer]], [[Subcutaneous fat necrosis of newborn]]
| bgcolor="Beige" | [[Breast cancer]], [[Ovarian cancer]], Subcutaneous fat necrosis of newborn
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
| bgcolor="Beige" | [[Acute adult t-cell leukemia ]] , [[Adenoma]], [[Adult t-cell leukemia]], [[Adult t-cell lymphoma ]] , [[Bone cancer]], [[Breast cancer]], [[Bronchial carcinoma]], [[Chronic adult t-cell leukemia ]] , [[Growth hormone secreting pituitary adenoma]], [[Hematologic malignancy]], [[Hepatocellular carcinoma]], [[Hodgkin's lymphoma]], [[Hypercalcemia of malignancy]], [[Kidney cancer]], [[Lymphoma]], [[Metastatic neoplasm]], [[Multiple endocrine neoplasia]], [[Multiple myeloma]], [[Osteolytic bone metastases and local cytokines]], [[Osteomalacia]], [[Ovarian cancer]], [[Paraneoplastic syndrome]], [[Parathyroid carcinoma]], [[Parathyroid hyperplasia]],  [[Pheochromocytoma]], [[Pituitary tumour ]] , [[Plasma cell granuloma]], [[Silicone-induced granuloma]], [[Smoldering adult t-cell leukemia ]] , [[Vasoactive intestinal polypeptide-producing tumor]]
| bgcolor="Beige" | [[Acute adult T-cell leukemia]], [[Adenoma]], [[Adult T-cell leukemia]], [[Adult T-cell leukemia|Adult T-cell lymphoma]], [[Bone cancer]], [[Breast cancer]], [[Bronchial carcinoma]], [[Chronic adult T-cell leukemia]], [[Growth hormone secreting pituitary adenoma]], [[Hematologic malignancy]], [[Hepatocellular carcinoma]], [[Hodgkin's lymphoma]], Hypercalcemia of malignancy, [[Renal cancer]], [[Lymphoma]], [[Metastatic neoplasm]], [[Multiple endocrine neoplasia]], [[Multiple myeloma]], Osteolytic bone metastases and local cytokines, [[Osteomalacia]], [[Ovarian cancer]], [[Paraneoplastic syndrome]], [[Parathyroid adenoma]], [[Parathyroid carcinoma]], Parathyroid hyperplasia,  [[Pheochromocytoma]], [[Pituitary tumor|Pituitary tumour]], Plasma cell granuloma, Silicone-induced granuloma, [[Adult T-cell leukemia|Smoldering adult T-cell leukemia]], [[Vasoactive intestinal polypeptide-producing tumor]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
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|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
| '''Overdose / Toxicity'''
| bgcolor="Beige" | , [[Aluminum]] intoxication, [[Aspirin]] (in large amounts), [[Drugs]], [[Hypervitaminosis D]], [[Vitamin A]] intoxication, [[Vitamin D]] intoxication
| bgcolor="Beige" | [[Aluminum]] intoxication, [[Aspirin]] (in large amounts), [[Drugs]], [[Hypervitaminosis A]], [[Hypervitaminosis D]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
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|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
| bgcolor="Beige" | [[Berylliosis]], [[Bronchial carcinoma]], [[Coccidioidomycosis]], [[Histoplasmosis]], [[Mycobacterium tuberculosis]],  [[Sarcoidosis]], [[Tuberculosis]]
| bgcolor="Beige" | [[Berylliosis]], [[Bronchial carcinoma]], [[Coccidioidomycosis]], [[Histoplasmosis]], [[Sarcoidosis]], [[Tuberculosis]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| '''Renal / Electrolyte'''
| bgcolor="Beige" | [[Acute renal failure]], [[Bartter's syndrome]], [[Gitelman syndrome]], [[Hypokalaemic distal renal tubular acidosis]], [[Hypophosphataemia]], [[Hypophosphatasia ]] , [[Kidney cancer]], [[Kidney transplant]], [[Milk-alkali syndrome]], [[Renal failure]], [[Rhabdomyolysis]]
| bgcolor="Beige" | [[Acute renal failure]], [[Bartter's syndrome]], [[Gitelman syndrome]], [[Hypokalaemic distal renal tubular acidosis]], [[Hypophosphataemia]], [[Hypophosphatasia]], [[Renal cancer]], [[Kidney transplant]], [[Milk-alkali syndrome]], [[Renal failure]], [[Rhabdomyolysis]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| '''Rheum / Immune / Allergy'''
| bgcolor="Beige" | [[Chronic granulomatous disorders]]
| bgcolor="Beige" | Chronic granulomatous disorders, [[Sarcoidosis]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
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|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
| bgcolor="Beige" | [[Bone fracture]], [[Dehydration]]
| bgcolor="Beige" | [[Bone fracture]], [[Dehydration]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
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===Causes in Alphabetical Order===
===Causes in Alphabetical Order===
{{columns-list|3|
<div style="-moz-column-count:3; column-count:3;">
*[[Abnormal parathyroid gland function]]
*Abnormal parathyroid gland function
*[[Acromegaly]]
*[[Acromegaly]]
*[[Activation of extrarenal 1 alpha-hydroxylase ]]
*Activation of extra-renal 1 alpha-hydroxylase
*[[Acute adult t-cell leukemia ]]
*[[Acute adult T-cell leukemia]]
*[[Acute renal failure]]
*[[Acute renal failure]]
*[[Addison's disease]]
*[[Addison's disease]]
*[[Adenoma]]
*[[Adenoma]]
*[[Adrenal cortex insufficiency]]
*[[Adrenal cortex insufficiency]]
*[[Adrenal insufficiency]]
*[[Adult T-cell leukemia]]
*[[Adult t-cell leukemia]]
*Aluminium antacid overuse
*[[Adult t-cell lymphoma ]]
*[[Aluminum]] intoxication
*[[Aluminium antacid overuse]]
*[[Aspirin]] (in large amounts)
*[[Aluminum intoxication]]
*[[Bartter's syndrome]]
*[[Bartter's syndrome]]
*[[Berylliosis]]
*[[Berylliosis]]
*[[Beuren-williams syndrome]]
*[[Beuren-Williams syndrome]]
*[[Bone breakdown]]
*[[Blue diaper syndrome]]
*[[Bone cancer]]
*[[Bone cancer]]
*[[Bone fracture]]
*[[Bone fracture]]
*[[Breast cancer]]
*[[Breast cancer]]
*[[Bronchial carcinoma]]
*[[Bronchial carcinoma]]
*[[Brown-sequard syndrome ]]
*[[Brown-Sequard syndrome]] 
*[[Calcium acetate]]
*[[Calcium acetate]]
*[[Caspofungin acetate]]
*[[Caspofungin acetate]]
*[[Cefepime]]
*[[Cefepime]]
*[[Chlortalidone]]
*[[Chlortalidone]]
*[[Chronic adult t-cell leukemia ]]
*[[Chronic adult T-cell leukemia]]
*[[Chronic granulomatous disorders]]
*Chronic granulomatous disorders
*[[Chronic kidney disease]]
*[[Chronic renal failure]]
*[[Cidofovir]]
*[[Cidofovir]]
*[[Coccidioidomycosis]]
*[[Coccidioidomycosis]]
*[[Cuffed blood sample]]
*Conenital lactase deficiency
*Cuffed blood sample
*[[Cushing's syndrome]]
*[[Cushing's syndrome]]
*[[Danazol]]
*[[Danazol]]
*[[Dehydration]]
*[[Dehydration]]
*[[Dexlansoprazole]]
*[[Dexlansoprazole]]
*Dietary phosphate deficiency
*[[Diuretics]]
*[[Diuretics]]
*[[Estrogen]]
*[[Excessive vitamin a]]
*[[Excessive vitamin a]]
*[[Familial hypocalcuric hypercalcemia]]
*[[Familial hypocalciuric hypercalcemia]]
*[[Familial isolated hyperparathyroidism]]
*Familial isolated hyperparathyroidism
*[[Fluoxymesterone]]
*[[Fluoxymesterone]]
*[[Gestrinone]]
*[[Gestrinone]]
Line 223: Line 229:
*[[Histoplasmosis]]
*[[Histoplasmosis]]
*[[Hodgkin's lymphoma]]
*[[Hodgkin's lymphoma]]
*[[Hypercalcemia of malignancy]]
*[[Hypercalcemia]] of [[malignancy]]
*[[Hyperparathyroidism ]]
*[[Hyperparathyroidism ]]
*[[Hyperparathyroidism|Familial isolated hyperparathyroidism]]
*[[Hyperparathyroidism|Neonatal severe primary hyperparathyroidism]]
*[[Hyperthyroidism]]
*[[Hyperthyroidism]]
*[[Hypervitaminosis a]]
*[[Hypervitaminosis A]]
*[[Hypervitaminosis d]]
*[[Hypervitaminosis D]]
*[[Hypokalaemic distal renal tubular acidosis]]
*[[Hypokalaemic distal renal tubular acidosis]]
*[[Hypoparathyroidism]]
*[[Hypoparathyroidism]]
*[[Hypophosphataemia]]
*[[Hypophosphataemia]]
*[[Hypophosphatasia ]]
*[[Hypophosphatasia]]
*Idiopathic infantile hypercalcemia (Williams syndrome)
*[[Idiopathic]] hypercalcemia (in infants)
*[[Immobilization]]
*[[Immobilization]]
*[[Infantile hypophosphatasia ]]
*[[Infantile hypophosphatasia ]]
Line 245: Line 255:
*[[Metastatic neoplasm]]
*[[Metastatic neoplasm]]
*[[Milk-alkali syndrome]]
*[[Milk-alkali syndrome]]
*[[Miscellaneous]]
*[[Multiple endocrine neoplasia]]
*[[Multiple endocrine neoplasia]]
*[[Multiple myeloma]]
*[[Multiple myeloma]]  
*Mutations of the calcium-sensing receptor
*[[Mycobacterium tuberculosis]]
*[[Mycobacterium tuberculosis]]
*[[Nandrolone]]
*[[Nandrolone]]
*[[Neonatal severe primary hyperparathyroidism]]
*Neonatal severe hyperparathyroidism
*[[Non-parathyroid mediated]]
*Neonatal severe primary hyperparathyroidism
*[[Oral candidiasis]]
*[[Oral candidiasis]]
*[[Osteolytic bone metastases and local cytokines]]
*Osteolytic bone metastases and local cytokines
*[[Osteomalacia]]
*[[Osteomalacia]]
*[[Osteoporosis]]
*[[Osteoporosis]]
*[[Ovarian cancer]]
*[[Ovarian cancer]]
*[[Paget's disease of bone]]
*[[Paget's disease]]
*[[Paget's disease]]
*[[Paget's disease of bone]]
*[[Paraneoplastic syndrome]]
*[[Paraneoplastic syndrome]]
*[[Paraplegia]]
*[[Paraplegia]]
*[[Parathyroid carcinoma]]
*[[Parathyroid adenoma]]
*[[Parathyroid hormone related peptide]]
*[[Parathyroid cancer|Parathyroid carcinoma]]
*[[Parathyroid hyperplasia]]
*Parathyroid hormone related peptide
*[[Parathyroid mediated]]
*[[Parenteral nutrition]]
*[[Parenteral nutrition]]
*[[Paricalcitol]]
*[[Paricalcitol]]
*[[Pheochromocytoma]]
*[[Pheochromocytoma]]
*[[Phosphoethanolaminuria]]
*Phosphoethanolaminuria
*[[Pituitary tumour ]]
*[[Pituitary tumour ]]
*[[Plasma cell granuloma]]
*[[Plasma cell granuloma]]
*[[Polycythemia]]
*[[Polycythemia]]
*Post [[renal transplantation]]
*[[Primary hyperparathyroidism]]
*[[Pseudophosphatasia ]]
*[[Pseudophosphatasia ]]
*[[Pthrp]]
*[[Renal cancer]]
*[[Renal failure]]
*[[Renal failure]]
*[[Rhabdomyolysis]]
*[[Rhabdomyolysis]]
*[[Sarcoidosis]]
*[[Sarcoidosis]]
*[[Secondary hyperparathyroidism]] (long standing)
*[[Silicone-induced granuloma]]
*[[Silicone-induced granuloma]]
*[[Sjogren's syndrome]]
*[[Sjogren's syndrome]]
*[[Smoldering adult t-cell leukemia ]]
*[[Smoldering adult t-cell leukemia |Smoldering adult T-cell leukemia]]
*[[Subcutaneous fat necrosis of newborn]]
*Subcutaneous fat necrosis of newborn
*Subcutaneous fat necrosis
*[[Tamoxifen]]
*[[Tamoxifen]]
*[[Teriparatide]]
*[[Teriparatide]]
*[[Theophylline toxicity]]
*Tertiary hyperparathyroidism
*[[Theophylline|Theophylline toxicity]]
*[[Thiazide]]
*[[Thiazide]]
*[[Toremifene]]
*[[Toremifene]]
*[[Tryptophan malabsorption syndrome]]
*Tryptophan malabsorption syndrome
*[[Tuberculosis]]
*[[Tuberculosis]]
*[[Vasoactive intestinal polypeptide-producing tumor]]
*[[Vasoactive intestinal polypeptide-producing tumor]]
*[[Vipoma]]
*[[Vipoma]]
*[[Vitamin d overdose]]
*[[William's syndrome]]
*[[William's syndrome]]
}}
</div>


==References==
==References==

Latest revision as of 20:26, 5 July 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2], Luke Rusowicz-Orazem, B.S.

Overview

Hypercalcemia is most commonly caused by hyperparathyroidism and malignancy. Other causes of hypercalcemia include hyperthyroidism, vitamin D toxicity, increased calcium intake, granulomatous diseases ( such sarcoidosis), and various renal disorders.

Causes

Life-Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Severity of hypercalcemia is more related to life-threatening situations rather that particular cause.

Common Causes

Common causes of hypercalcemia include:[1]

Less Common Cause

Less common causes of hypercalcemia include:[1]

Causes by Organ System

Cardiovascular Beuren-Williams syndrome, Vasoactive intestinal polypeptide-producing tumor
Chemical / poisoning Aluminium antacid overuse, Aluminum intoxication, Calcium acetate, Caspofungin acetate, Cefepime, Chlortalidone, Theophylline toxicity
Dermatologic Leprosy, Subcutaneous fat necrosis of newborn
Drug Side Effect Cidofovir, Danazol, Dexlansoprazole, Diuretics, Fluoxymesterone, Gestrinone, Lithium, Nandrolone, Paricalcitol, Tamoxifen, Teriparatide, Thiazide, Toremifene
Ear Nose Throat Oral candidiasis, Sjogren's syndrome
Endocrine Abnormal parathyroid gland function, Acromegaly, Addison's disease, Adenoma, Adrenal cortex insufficiency, Adrenal insufficiency, Adult T-cell leukemia, Bartter's syndrome, Cushing's syndrome, Familial hypocalciuric hypercalcemia, Familial isolated hyperparathyroidism, Growth hormone-secreting pituitary adenoma, Hypercalcemia of malignancy, Hyperparathyroidism , Hyperthyroidism, Multiple endocrine neoplasia, Neonatal severe primary hyperparathyroidism, Paget's disease of bone, Parathyroid adenoma, Parathyroid carcinoma, Parathyroid hormone-related peptide, Parathyroid hyperplasia, Pituitary tumour, Tryptophan malabsorption syndrome
Environmental No underlying causes
Gastroenterologic Hepatocellular carcinoma, Vipoma
Genetic Activation of extra-renal 1 alpha-hydroxylase, Beuren-Williams syndrome, Familial isolated hyperparathyroidism, Metaphyseal chondrodysplasia, Phosphoethanolaminuria, Pseudophosphatasia, William's syndrome
Hematologic Acute adult T-cell leukemia, Adult T-cell leukemia, Chronic adult T-cell leukemia, Cuffed blood sample, Cushing's syndrome, Familial hypocalciuric hypercalcemia, Hematologic malignancy, Hodgkin's lymphoma, Hypervitaminosis A, Hypervitaminosis D, Hypokalaemic distal renal tubular acidosis, Hypophosphataemia, Hypophosphatasia, Leukemia, Lymphoma, Multiple myeloma, Plasma cell granuloma, Polycythemia, Pseudophosphatasia, Smoldering adult T-cell leukemia
Iatrogenic Kidney transplant
Infectious Disease Coccidioidomycosis, Histoplasmosis, Oral candidiasis, Tuberculosis
Musculoskeletal / Ortho Bone cancer, Bone fracture, Immobilization, Osteolytic bone metastases and local cytokines, Osteomalacia, Osteoporosis, Paget's disease of bone, Paraplegia
Neurologic Adrenal cortex insufficiency, Brown-Sequard syndrome 
Nutritional / Metabolic Milk-alkali syndrome, Parenteral nutrition
Obstetric/Gynecologic Breast cancer, Ovarian cancer, Subcutaneous fat necrosis of newborn
Oncologic Acute adult T-cell leukemia, Adenoma, Adult T-cell leukemia, Adult T-cell lymphoma, Bone cancer, Breast cancer, Bronchial carcinoma, Chronic adult T-cell leukemia, Growth hormone secreting pituitary adenoma, Hematologic malignancy, Hepatocellular carcinoma, Hodgkin's lymphoma, Hypercalcemia of malignancy, Renal cancer, Lymphoma, Metastatic neoplasm, Multiple endocrine neoplasia, Multiple myeloma, Osteolytic bone metastases and local cytokines, Osteomalacia, Ovarian cancer, Paraneoplastic syndrome, Parathyroid adenoma, Parathyroid carcinoma, Parathyroid hyperplasia, Pheochromocytoma, Pituitary tumour, Plasma cell granuloma, Silicone-induced granuloma, Smoldering adult T-cell leukemia, Vasoactive intestinal polypeptide-producing tumor
Ophthalmologic No underlying causes
Overdose / Toxicity Aluminum intoxication, Aspirin (in large amounts), Drugs, Hypervitaminosis A, Hypervitaminosis D
Psychiatric No underlying causes
Pulmonary Berylliosis, Bronchial carcinoma, Coccidioidomycosis, Histoplasmosis, Sarcoidosis, Tuberculosis
Renal / Electrolyte Acute renal failure, Bartter's syndrome, Gitelman syndrome, Hypokalaemic distal renal tubular acidosis, Hypophosphataemia, Hypophosphatasia, Renal cancer, Kidney transplant, Milk-alkali syndrome, Renal failure, Rhabdomyolysis
Rheum / Immune / Allergy Chronic granulomatous disorders, Sarcoidosis
Sexual No underlying causes
Trauma Bone fracture, Dehydration
Urologic Acute renal failure, Chronic renal failure, Milk-alkali syndrome, Renal failure
Miscellaneous Idiopathic hypercalcemia (in infants), Immobilization, Paraplegia

Causes in Alphabetical Order

References

  1. ↑ 1.0 1.1 Carroll R, Matfin G (2010). "Endocrine and metabolic emergencies: hypercalcaemia". Ther Adv Endocrinol Metab. 1 (5): 225–34. doi:10.1177/2042018810390260. PMC 3474617. PMID 23148166.
  2. ↑ Peacock M (2002). "Primary hyperparathyroidism and the kidney: biochemical and clinical spectrum". J. Bone Miner. Res. 17 Suppl 2: N87–94. PMID 12412783.
  3. ↑ Silverberg SJ, Shane E, de la Cruz L, Dempster DW, Feldman F, Seldin D, Jacobs TP, Siris ES, Cafferty M, Parisien MV (1989). "Skeletal disease in primary hyperparathyroidism". J. Bone Miner. Res. 4 (3): 283–91. doi:10.1002/jbmr.5650040302. PMID 2763869.
  4. ↑ Wieneke JA, Smith A (2008). "Parathyroid adenoma". Head Neck Pathol. 2 (4): 305–8. doi:10.1007/s12105-008-0088-8. PMC 2807581. PMID 20614300.
  5. ↑ Rodriguez M, Nemeth E, Martin D (2005). "The calcium-sensing receptor: a key factor in the pathogenesis of secondary hyperparathyroidism". Am J Physiol Renal Physiol. 288 (2): F253–64. doi:10.1152/ajprenal.00302.2004. PMID 15507543.
  6. ↑ Kilgo MS, Pirsch JD, Warner TF, Starling JR (1998). "Tertiary hyperparathyroidism after renal transplantation: surgical strategy". Surgery. 124 (4): 677–83, discussion 683–4. doi:10.1067/msy.1998.91483. PMID 9780988.
  7. ↑ Mirrakhimov AE (2015). "Hypercalcemia of Malignancy: An Update on Pathogenesis and Management". N Am J Med Sci. 7 (11): 483–93. doi:10.4103/1947-2714.170600. PMC 4683803. PMID 26713296.
  8. ↑ Stewart AF (2005). "Clinical practice. Hypercalcemia associated with cancer". N Engl J Med. 352 (4): 373–9. doi:10.1056/NEJMcp042806. PMID 15673803.
  9. ↑ Burman KD, Monchik JM, Earll JM, Wartofsky L (1976). "Ionized and total serum calcium and parathyroid hormone in hyperthyroidism". Ann Intern Med. 84 (6): 668–71. PMID 937877.
  10. ↑ Iqbal AA, Burgess EH, Gallina DL, Nanes MS, Cook CB (2003). "Hypercalcemia in hyperthyroidism: patterns of serum calcium, parathyroid hormone, and 1,25-dihydroxyvitamin D3 levels during management of thyrotoxicosis". Endocr Pract. 9 (6): 517–21. doi:10.4158/EP.9.6.517. PMID 14715479.
  11. ↑ Hoeck HC, Laurberg G, Laurberg P (1994). "Hypercalcaemic crisis after excessive topical use of a vitamin D derivative". J. Intern. Med. 235 (3): 281–2. PMID 8120527.
  12. ↑ Jacobus CH, Holick MF, Shao Q, Chen TC, Holm IA, Kolodny JM, Fuleihan GE, Seely EW (1992). "Hypervitaminosis D associated with drinking milk". N. Engl. J. Med. 326 (18): 1173–7. doi:10.1056/NEJM199204303261801. PMID 1313547.
  13. ↑ Sharma OP (1996). "Vitamin D, calcium, and sarcoidosis". Chest. 109 (2): 535–9. PMID 8620732.
  14. ↑ Meric F, Yap P, Bia MJ (1990). "Etiology of hypercalcemia in hemodialysis patients on calcium carbonate therapy". Am J Kidney Dis. 16 (5): 459–64. PMID 2239937.
  15. ↑ Dusso AS, Kamimura S, Gallieni M, Zhong M, Negrea L, Shapiro S, Slatopolsky E (1997). "gamma-Interferon-induced resistance to 1,25-(OH)2 D3 in human monocytes and macrophages: a mechanism for the hypercalcemia of various granulomatoses". J. Clin. Endocrinol. Metab. 82 (7): 2222–32. doi:10.1210/jcem.82.7.4074. PMID 9215298.
  16. ↑ Vanstone MB, Oberfield SE, Shader L, Ardeshirpour L, Carpenter TO (2012). "Hypercalcemia in children receiving pharmacologic doses of vitamin D." Pediatrics. 129 (4): e1060–3. doi:10.1542/peds.2011-1663. PMID 22412034.
  17. ↑ Vargas-Poussou R, Mansour-Hendili L, Baron S, Bertocchio JP, Travers C, Simian C; et al. (2016). "Familial Hypocalciuric Hypercalcemia Types 1 and 3 and Primary Hyperparathyroidism: Similarities and Differences". J Clin Endocrinol Metab. 101 (5): 2185–95. doi:10.1210/jc.2015-3442. PMID 26963950.
  18. ↑ Mallette LE, Khouri K, Zengotita H, Hollis BW, Malini S (1989). "Lithium treatment increases intact and midregion parathyroid hormone and parathyroid volume". J. Clin. Endocrinol. Metab. 68 (3): 654–60. doi:10.1210/jcem-68-3-654. PMID 2918061.
  19. ↑ Griebeler ML, Kearns AE, Ryu E, Thapa P, Hathcock MA, Melton LJ; et al. (2016). "Thiazide-Associated Hypercalcemia: Incidence and Association With Primary Hyperparathyroidism Over Two Decades". J Clin Endocrinol Metab. 101 (3): 1166–73. doi:10.1210/jc.2015-3964. PMC 4803175. PMID 26751196.

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