Hypercalcemia laboratory findings: Difference between revisions
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{{Hypercalcemia}} | {{Hypercalcemia}} | ||
{{CMG}} | {{CMG}}; {{AE}}{{Anmol}} | ||
==Overview== | ==Overview== | ||
Routine panel is recommended for patients suspected of hypercalcemia to diagnosed the underlying cause. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
The following test may be done as a routine panel if a person is suspected of hypercalcemia: | |||
* Complete blood count ([[CBC]]) | * Complete blood count ([[CBC]]) | ||
* Serum and urinary [[calcium]] | * Serum and urinary [[calcium]] | ||
| Line 15: | Line 18: | ||
* [[Vitamin D]] | * [[Vitamin D]] | ||
* [[Magnesium]] | * [[Magnesium]] | ||
==Biochemical tests== | |||
===Serum Calcium=== | |||
*An elevated serum [[calcium]] on routine biochemical screening in a asymptomatic patient should raise the suspicion of primary hyperparathyroidism.<ref name="pmid8964825">{{cite journal |vauthors=Silverberg SJ, Bilezikian JP |title=Evaluation and management of primary hyperparathyroidism |journal=J. Clin. Endocrinol. Metab. |volume=81 |issue=6 |pages=2036–40 |year=1996 |pmid=8964825 |doi=10.1210/jcem.81.6.8964825 |url=https://watermark.silverchair.com/api/watermark?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAfQwggHwBgkqhkiG9w0BBwagggHhMIIB3QIBADCCAdYGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMs2QB8t_zFXzSZJ4bAgEQgIIBp8fw3_iunlmFW1rMhoY9MDPeg_lHu7iYzuIrfwXHubghqdXOMvdWyttCOOgR3PHFZtE5IkmNB4hRahVQsPzHGwh5kiBmLGp9W8OQwFxrCIH0sBqjOxOiYc_yGAs0ybxF1mEh929-YxivBBC43EW1yFtSmwplSQfAWah7w6yxXbUhV8umq3pGQxqYDClp47IR7TyVeEneWZz85Z7MS80V4c-yZPG1ZPxQR-1kPk3rdji_8bAeXwJKRGScWzKPqSEQvXFWLV4sHwqgTrU53HSkURUJb8u-w4EOHMjtUATJPoGgFsZOcrf_xtPBZmcI_v5G3RO_cJDHueDwQNfRaGIO2ztcToFGmVpER4vGhqfrtr7mXHPNPyUUOa-_KWPE-qxDrUCG8kevm0tM8MButJkAmVdBxrIC4mSd8sAZb3KcfSKt9RUXFJpIiDoOut21ZFEGEU8O7vwjw4RhxridsegEUiCFWCxHftX9qUqELn90AJ2Fg1olxH9jI46KnEJPd7MNYReTvdeX5erBZmXjmP5oCT6vLYUbRLjXxyJQRl-d5N9O0vfTgZ5bbA}}</ref> | |||
*Measurement of total serum [[calcium]] with automatic techniques has similar or even more reliability than serum ionized [[calcium]] measurement. | |||
*An elevated serum [[calcium]] should be confirmed by repeat measurement. | |||
*20% of patients with proven primary hyperparathyroidism have normal total [[calcium]] and elevated [[parathyroid hormone]]. Serum ionized concentration measurement is helpful in such cases.<ref name="pmid9612524">{{cite journal |vauthors=Glendenning P, Gutteridge DH, Retallack RW, Stuckey BG, Kermode DG, Kent GN |title=High prevalence of normal total calcium and intact PTH in 60 patients with proven primary hyperparathyroidism: a challenge to current diagnostic criteria |journal=Aust N Z J Med |volume=28 |issue=2 |pages=173–8 |year=1998 |pmid=9612524 |doi= |url=}}</ref> | |||
*Some patients with primary hyperparathyroidism may have elevated concentration of serum [[parathyroid hormone]] with normal serum [[calcium]], which is usually suggestive of normocalcemic primary hyperparathyroidism.<ref name="pmid19193910">{{cite journal |vauthors=Silverberg SJ, Lewiecki EM, Mosekilde L, Peacock M, Rubin MR |title=Presentation of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop |journal=J. Clin. Endocrinol. Metab. |volume=94 |issue=2 |pages=351–65 |year=2009 |pmid=19193910 |pmc=5393372 |doi=10.1210/jc.2008-1760 |url=}}</ref> Causes of secondary hyperparathyroidism should be rules out for making the diagnosis of normocalcemic primary hyperparathyroidism. Normocalcemic primary hyperparathyroidism might represent the first symptomatic stage of primary hyperparathyroidism.<ref name="pmid17536001">{{cite journal |vauthors=Lowe H, McMahon DJ, Rubin MR, Bilezikian JP, Silverberg SJ |title=Normocalcemic primary hyperparathyroidism: further characterization of a new clinical phenotype |journal=J. Clin. Endocrinol. Metab. |volume=92 |issue=8 |pages=3001–5 |year=2007 |pmid=17536001 |doi=10.1210/jc.2006-2802 |url=}}</ref> | |||
===Serum Parathyroid hormone=== | |||
*Method of choice for measuring intact parathyroid hormone include Immunoradiometric assay (IMRA) or Immunochemiluminescent assay (ICMA).<ref name="pmid1993319">{{cite journal |vauthors=Endres DB, Villanueva R, Sharp CF, Singer FR |title=Immunochemiluminometric and immunoradiometric determinations of intact and total immunoreactive parathyrin: performance in the differential diagnosis of hypercalcemia and hypoparathyroidism |journal=Clin. Chem. |volume=37 |issue=2 |pages=162–8 |year=1991 |pmid=1993319 |doi= |url=http://clinchem.aaccjnls.org/content/clinchem/37/2/162.full.pdf}}</ref> | |||
===24-Hour urinary calcium=== | |||
*24-Hour urinary [[calcium]] excretion is indicated by the urinary calcium:creatinine clearance ratio.<ref name="pmid7356229">{{cite journal |vauthors=Marx SJ, Stock JL, Attie MF, Downs RW, Gardner DG, Brown EM, Spiegel AM, Doppman JL, Brennan MF |title=Familial hypocalciuric hypercalcemia: recognition among patients referred after unsuccessful parathyroid exploration |journal=Ann. Intern. Med. |volume=92 |issue=3 |pages=351–6 |year=1980 |pmid=7356229 |doi= |url=}}</ref><ref name="pmid686009">{{cite journal |vauthors=Marx SJ, Spiegel AM, Brown EM, Koehler JO, Gardner DG, Brennan MF, Aurbach GD |title=Divalent cation metabolism. Familial hypocalciuric hypercalcemia versus typical primary hyperparathyroidism |journal=Am. J. Med. |volume=6http://www.sciencedirect.com/science/article/pii/0002934378908148?via%3Dihub5 |issue=2 |pages=235–42 |year=1978 |pmid=686009 |doi=10.1016/0002-9343(78)90814-8 |url=}}</ref> | |||
*It is used to seperate the patients with [[familial hypocalciuric hypercalcemia]] and typical primary hyperparathyroidism. | |||
===Serum 1,25-dihydroxy vitamin D=== | |||
*May be used to differentiate between Familial hypercalciuric hypercalcemia (FHH) with primary hyperparathyroidism.<ref name="pmid6699136">{{cite journal |vauthors=Law WM, Bollman S, Kumar R, Heath H |title=Vitamin D metabolism in familial benign hypercalcemia (hypocalciuric hypercalcemia) differs from that in primary hyperparathyroidism |journal=J. Clin. Endocrinol. Metab. |volume=58 |issue=4 |pages=744–7 |year=1984 |pmid=6699136 |doi=10.1210/jcem-58-4-744 |url=}}</ref><ref name="pmid18787045">{{cite journal |vauthors=Christensen SE, Nissen PH, Vestergaard P, Heickendorff L, Rejnmark L, Brixen K, Mosekilde L |title=Plasma 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and parathyroid hormone in familial hypocalciuric hypercalcemia and primary hyperparathyroidism |journal=Eur. J. Endocrinol. |volume=159 |issue=6 |pages=719–27 |year=2008 |pmid=18787045 |doi=10.1530/EJE-08-0440 |url=http://www.eje-online.org/content/159/6/719.full.pdf}}</ref> | |||
*Serum [[1,25-dihydroxy vitamin D]] ([[calcitriol]]) concentration are significantly lower in FHH than primary hyperparathyroidism. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Needs content]] | [[Category:Needs content]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category: | [[Category:Endocrinology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
{{WS}} | |||
{{WH}} | |||
Latest revision as of 14:18, 6 July 2018
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American Roentgen Ray Society Images of Hypercalcemia |
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]
Overview
Routine panel is recommended for patients suspected of hypercalcemia to diagnosed the underlying cause.
Laboratory Findings
The following test may be done as a routine panel if a person is suspected of hypercalcemia:
- Complete blood count (CBC)
- Serum and urinary calcium
- Blood urea nitrogen (BUN)/creatinine
- Parathyroid hormone (PTH)
- PTH-related peptide
- Albumin
- Phosphate
- Alkaline phosphatase
- Vitamin D
- Magnesium
Biochemical tests
Serum Calcium
- An elevated serum calcium on routine biochemical screening in a asymptomatic patient should raise the suspicion of primary hyperparathyroidism.[1]
- Measurement of total serum calcium with automatic techniques has similar or even more reliability than serum ionized calcium measurement.
- An elevated serum calcium should be confirmed by repeat measurement.
- 20% of patients with proven primary hyperparathyroidism have normal total calcium and elevated parathyroid hormone. Serum ionized concentration measurement is helpful in such cases.[2]
- Some patients with primary hyperparathyroidism may have elevated concentration of serum parathyroid hormone with normal serum calcium, which is usually suggestive of normocalcemic primary hyperparathyroidism.[3] Causes of secondary hyperparathyroidism should be rules out for making the diagnosis of normocalcemic primary hyperparathyroidism. Normocalcemic primary hyperparathyroidism might represent the first symptomatic stage of primary hyperparathyroidism.[4]
Serum Parathyroid hormone
- Method of choice for measuring intact parathyroid hormone include Immunoradiometric assay (IMRA) or Immunochemiluminescent assay (ICMA).[5]
24-Hour urinary calcium
- 24-Hour urinary calcium excretion is indicated by the urinary calcium:creatinine clearance ratio.[6][7]
- It is used to seperate the patients with familial hypocalciuric hypercalcemia and typical primary hyperparathyroidism.
Serum 1,25-dihydroxy vitamin D
- May be used to differentiate between Familial hypercalciuric hypercalcemia (FHH) with primary hyperparathyroidism.[8][9]
- Serum 1,25-dihydroxy vitamin D (calcitriol) concentration are significantly lower in FHH than primary hyperparathyroidism.
References
- ↑ Silverberg SJ, Bilezikian JP (1996). "Evaluation and management of primary hyperparathyroidism". J. Clin. Endocrinol. Metab. 81 (6): 2036–40. doi:10.1210/jcem.81.6.8964825. PMID 8964825.
- ↑ Glendenning P, Gutteridge DH, Retallack RW, Stuckey BG, Kermode DG, Kent GN (1998). "High prevalence of normal total calcium and intact PTH in 60 patients with proven primary hyperparathyroidism: a challenge to current diagnostic criteria". Aust N Z J Med. 28 (2): 173–8. PMID 9612524.
- ↑ Silverberg SJ, Lewiecki EM, Mosekilde L, Peacock M, Rubin MR (2009). "Presentation of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop". J. Clin. Endocrinol. Metab. 94 (2): 351–65. doi:10.1210/jc.2008-1760. PMC 5393372. PMID 19193910.
- ↑ Lowe H, McMahon DJ, Rubin MR, Bilezikian JP, Silverberg SJ (2007). "Normocalcemic primary hyperparathyroidism: further characterization of a new clinical phenotype". J. Clin. Endocrinol. Metab. 92 (8): 3001–5. doi:10.1210/jc.2006-2802. PMID 17536001.
- ↑ Endres DB, Villanueva R, Sharp CF, Singer FR (1991). "Immunochemiluminometric and immunoradiometric determinations of intact and total immunoreactive parathyrin: performance in the differential diagnosis of hypercalcemia and hypoparathyroidism" (PDF). Clin. Chem. 37 (2): 162–8. PMID 1993319.
- ↑ Marx SJ, Stock JL, Attie MF, Downs RW, Gardner DG, Brown EM, Spiegel AM, Doppman JL, Brennan MF (1980). "Familial hypocalciuric hypercalcemia: recognition among patients referred after unsuccessful parathyroid exploration". Ann. Intern. Med. 92 (3): 351–6. PMID 7356229.
- ↑ Marx SJ, Spiegel AM, Brown EM, Koehler JO, Gardner DG, Brennan MF, Aurbach GD (1978). "Divalent cation metabolism. Familial hypocalciuric hypercalcemia versus typical primary hyperparathyroidism". Am. J. Med. 6http://www.sciencedirect.com/science/article/pii/0002934378908148?via%3Dihub5 (2): 235–42. doi:10.1016/0002-9343(78)90814-8. PMID 686009.
- ↑ Law WM, Bollman S, Kumar R, Heath H (1984). "Vitamin D metabolism in familial benign hypercalcemia (hypocalciuric hypercalcemia) differs from that in primary hyperparathyroidism". J. Clin. Endocrinol. Metab. 58 (4): 744–7. doi:10.1210/jcem-58-4-744. PMID 6699136.
- ↑ Christensen SE, Nissen PH, Vestergaard P, Heickendorff L, Rejnmark L, Brixen K, Mosekilde L (2008). "Plasma 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and parathyroid hormone in familial hypocalciuric hypercalcemia and primary hyperparathyroidism" (PDF). Eur. J. Endocrinol. 159 (6): 719–27. doi:10.1530/EJE-08-0440. PMID 18787045.