Materiały źródłowe

• #1 Hypercalcemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430714/

  The prevalence of hypercalcemia in the general population is approximately 1% to 2%. About 90% of hypercalcemia cases are due to primary hyperparathyroidism and malignancy-associated hypercalcemia. The prevalence of primary hyperparathyroidism in the general population ranges from 0.2% to 0.8% and increases with age. Overall, 2% of all cancers are associated with hypercalcemia, but in the pediatric age group, the prevalence is less, about 0.4% to 1.3%. […] Hypercalcemia is often an incidental finding detected on labwork completed for other reasons. When calcium levels rise above 12 mg/dL, patients typically present with clinical signs and symptoms, including polyuria, polydipsia, constipation, weakness, neuropsychiatric effects, nausea, vomiting, fatigue, anorexia, and confusion. These symptoms occur mainly due to several factors, such as suppressed neural transmission, loss of the kidney’s concentrating ability, other renal dysfunction, and effects on the central nervous system.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-is-Hypercalcemia.aspx

  The rates of hypercalcemia in the general population is thought to be approximately 1% to 2%. […] Primary hypercalcemia, which is hypercalcemia not caused by another illness such as hormone imbalances or cancer, has a prevalence of approximately 0.2% to 0.8%. […] 2% of all cancer types are associated with hypercalcemia, but in pediatric age groups, 0.4% to 1.3% percent of cancers are associated with the illness.

• #3 Hypercalcemia: Causes, Symptoms, Diagnosis & Treatment

  https://www.ganeshdiagnostic.com/blog/hypercalcemia-causes-symptoms-diagnosis-and-treatment

  Primary hyperparathyroidism, an ailment in which the parathyroid glands yield too much parathyroid hormone (PTH), is the most common cause of hypercalcemia. This condition affects approximately 1 in 500 people, with a majority in women and older adults. […] The epidemiology of hypercalcemia varies depending on the underlying cause of the condition. […] Overall, hypercalcemia is more common in older adults and individuals with a history of cancer or certain medical conditions. Women suffer more than men. […] The incidence of hypercalcemia is difficult to determine due to the various underlying causes and the fact that many cases of mild hypercalcemia may go undiagnosed. However, it is crucial to be familiar with the risk factors for hypercalcemia and to seek medical attention if symptoms occur.

• #4 Epidemiological Aspects of Hypercalcemia of Malignancy | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-642-85073-8_5

  Hypercalcemia can be caused by many disorders, but is most commonly due to primary hyperparathyroidism and to malignant disease. Together, these account for more than 90% of all cases. […] However, the incidence of hypercalcemia of cancer, which has been estimated to be about 150 new cases per million persons per year, is not as high as the annual incidence rate of primary hyperparathyroidism (approximately 250 new cases per year). […] Muggia FM (1990) Overview of cancer-related hypercalcemia: epidemiology and etiology. […] Vassilopoulou-Sellin R, Newman BM, Taylor SH, Guinee VF (1993) Incidence of hypercalcemia in patients with malignancy referred to a comprehensive cancer center. Cancer 71:13091312.

• #5 Hypercalcemia – EMCrit Project

  https://emcrit.org/ibcc/hypercalcemia/

  Milk-alkali syndrome is now the third leading cause of hypercalcemia leading to hospital admission among patients without end-stage renal disease (following malignancy and primary hyperparathyroidism). Common scenarios include the following: […] Overall, ~90% of hypercalcemia is due to hyperparathyroidism or malignancy. Among critically ill patients (especially those with severe hypercalcemia), malignancy is the most likely cause.

• #6 Malignancy-Related Hypercalcemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482423/

  Hypercalcemia of malignancy occurs in approximately 20% of cancer patients at some point during their clinical course. The most common cancer associated with hypercalcemia is multiple myeloma. A prevalence study reports that hypercalcemia of malignancy is reported in about 2% to 3% of patients diagnosed with cancer, with the incidence gradually decreasing over the years due to improvements in treatment options. […] More than 90% of hypercalcemia cases are caused by primary hyperparathyroidism (PHPT) or malignancy-induced hypercalcemia, with malignancy being the most common cause of hypercalcemia in hospitalized patients. […] Malignancy is the most common cause of hypercalcemia in hospitalized patients. Although most cases are managed on an outpatient basis, severe hypercalcemia often requires inpatient treatment. The prognosis depends on the stage of the primary malignancy and the severity of the hypercalcemia. Patients with uncontrolled malignancy and severe hypercalcemia typically have a poor prognosis.

• #7 Hypercalcaemia: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/hypercalcaemia

  Hypercalcaemia is an uncommon problem. Primary hyperparathyroidism is the most common cause. It affects mainly postmenopausal women. The prevalence rate in the UK is around 1-7 per 1,000 adults, with an annual incidence of around 4-11 per 10,000 person-years in one Scottish study. […] Hypercalcaemia is the most frequently encountered endocrine/electrolyte disorder in malignancy-associated hospitalised patients. Its incidence is 15 per 100,000 person-years and it has been estimated that up to 20% of people with a malignancy will be affected by hypercalcaemia at some point in the course of their illness. […] The incidence in children is unknown but is thought to be less common than in adults.

• #8 Primary Hyperparathyroidism Presenting as Hypercalcemic Crisis | ACS

  https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v1n1/wachtel-hyperparathyroidism/

  Hypercalcemic crisis is an infrequent presentation of primary hyperparathyroidism (PHPT). […] PHPT is the most common cause of hypercalcemia in the ambulatory population. The incidence varies widely, from 0.4 to 21.6 cases per 100,000 adults annually. Elderly females are two to three times more likely to be affected. […] Approximately 1.6%6% of patients with PHPT present with hypercalcemic crisis. Hypercalcemic crisis is variably defined as an adjusted serum calcium level of 13.514 mg/dL, with accompanying signs and symptoms of hypercalcemia. […] Mainstays of treatment of hypercalcemic crisis include intravenous fluids, induced calciuresis, bisphosphonates, calcitonin, and dialysis. Surgical resection remains the only definitive therapy for PHPT, and expeditious surgery after medical stabilization is recommended for patients presenting in hypercalcemic crisis.

• #9 Disease Management: Hypercalcemia

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/hypercalcemia/default.htm

  Hypercalcemia is a common clinical problem that typically leads to a chronic and mild elevation of calcium blood levels. […] Approximately 90% of all cases of hypercalcemia in the outpatient setting are caused by either primary HPT or hypercalcemia of malignancy. […] The incidence of primary HPT increases with age in both sexes but more so in women after menopause. […] The incidence is 12 to 24 per 100,000 person years for both sexes younger than 50 years but at ages 50 to 59, the incidence rises to 80 per 100,000 for women versus 36 for men. […] The incidence of primary HPT is highest among blacks (92 women; 46 men) followed by whites (81 women; 29 men) while rates for Asians (52 women, 28 men) and Hispanics (49 women, 17 men) are lower. […] Several studies have found excessive mortality in patients with HPT, with most of the excess caused by cardiovascular disease. […] The largest study, which included 4,461 Swedish patients, showed risk ratios for death from cardiovascular disease of 1.71 for men and 1.85 for women.

• #10

  https://link.springer.com/article/10.1007/BF01665300

  Primary hyperparathyroidism (HPT) is a common disorder that mainly afflicts elderly women. It can be diagnosed in at least 1% of all postmenopausal females and autopsy studies indicate an even higher frequency. […] Although the widespread use of automated serum calcium analyses has increased the awareness of HPT, only 10% of all cases seem to be identified. […] Various cardiovascular risk factors appear more commonly in patients with HPT and untreated disease is associated with an increased risk of premature death.

• #11 Hypercalcemia of malignancy and new treatment options | TCRM

  https://www.dovepress.com/hypercalcemia-of-malignancy-and-new-treatment-options-peer-reviewed-fulltext-article-TCRM

  Hypercalcemia of malignancy now occurs in upward of 20% of cancer patients during the course of their disease. […] While exact estimates vary as a function of the population studied and the serum calcium cutoff used, hypercalcemia of malignancy is both the most common cause of hypercalcemia in cancer patients and the leading cause of hypercalcemia in the inpatient setting. […] Among all cancers, multiple myeloma appears to be the cancer with the highest prevalence of hypercalcemia. […] With respect to solid cancers, breast and renal carcinomas followed by squamous carcinomas of any origin are the most common culprits. […] Among liquid malignancies, multiple myeloma is the most prevalent hematologic cancer associated with hypercalcemia followed by leukemia and non-Hodgkins lymphoma.

• #12 Management of Hypercalcemia of Malignancy

  https://jhoponline.com/issue-archive/2016-issues/march-vol-6-no-1/management-of-hypercalcemia-of-malignancy

  Hypercalcemia is defined as a condition in which the serum calcium level is 10.5 mg/dL (the upper limit of normal) or the ionized calcium level exceeds 5.6 mg/dL. […] Malignancy is a common cause of hypercalcemia, particularly when bone metastases exist. […] Hypercalcemia occurs in approximately 20% to 30% of patients with cancer at some time during the course of their disease, and is encountered predominantly among hospitalized patients, whereas primary hyperparathyroidism accounts for the majority of outpatient cases. […] Hypercalcemia is a common complication of various types of cancer, including squamous-cell carcinoma, multiple myeloma, T-cell lymphoma, and breast carcinoma. […] There are 4 major types of hypercalcemia associated with cancer, including humoral hypercalcemia of malignancy (HHM), local osteolytic hypercalcemia, calcitriol-secreting lymphoma, and ectopic hyperparathyroidism.

• #13 Epidemiology, clinical features, and management of severe hypercalcemia in critically ill patients | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0606-8

  Severe hypercalcemia (HCM) is a common reason for admission in intensive-care unit (ICU). […] Epidemiological data focusing on HCM in ICU are scarce. In a multicentric retrospective study, severe hypercalcemia (defined by a ionized calcemia2.9 mEq/L or 1.45 mmol/L) occurred in 2% of critically ill patients. […] Recent epidemiological studies estimate that HCM affects between 0.65 and 3% of all oncology patients. […] However, there are no data available on etiologies responsible for HCM in ICU patients. […] Our objectives were to characterize clinical and biological features of HCM, to identify risk factors for complications of HCM and risk factors of mortality. […] ICU mortality and hospital mortality rate were 9.9% and 21.3%, respectively. […] In multivariate analysis, an underlying solid tumor was independently associated with hospital mortality.

• #14 Hypercalcemia: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/766373-overview

  Hypercalcemia is relatively common and often is mild but of long duration. The incidence of hyperparathyroidism alone is approximately 1-2 cases per 1000 adults. Mild cases are often not diagnosed. A review of cancer-related hypercalcemia found that rates varied by tumor type, being highest in multiple myeloma (7.5-10.2%) and lowest in prostate cancer (1.4-2.1%). […] […] Screenings of large groups of patients have found prevalence rates as high as 39 cases per 1000 persons in Scandinavia. Similar screenings in South Africa showed a prevalence of 8 cases per 1000 persons. These higher incidences may reflect underdiagnosis in the United States rather than a true difference in prevalence.

• #15 Hypercalcemia of malignancy and new treatment options | TCRM

  https://www.dovepress.com/hypercalcemia-of-malignancy-and-new-treatment-options-peer-reviewed-fulltext-article-TCRM

  Humoral hypercalcemia of malignancy now accounts for approximately 80% of hypercalcemia in cancer patients and is often attributed to squamous cell carcinomas as well as kidney, bladder, and ovarian cancers. […] An important epidemiological caveat is the coexistence of hyperparathyroidism with hypercalcemia of malignancy. […] Affecting perhaps 10% of patients with concomitant cancer-related hypercalcemia, primary hyperparathyroidism is diagnosed via an inappropriately high-normal serum PTH level in the presence of hypercalcemia.

• #16 Hypercalcemia – Office Instructions – ENT Specialty Care

  https://www.entspecialtycare.com/provider-physician/instructions-hypercalcemia/

  Hypercalcemia is a relatively common clinical problem. The most common causes of hypercalcemia affecting 90% of all patients are primary hyperparathyroidism (HPT) and malignancy. The incidence of HPT is approximately 4 per 100,000 per year. Symptoms of hypercalcemia are nonspecific and are related to the severity and rate of change of the serum calcium level. Patients with HPT can present with any of the clinical manifestations summarized in Table 1 and this diagnosis needs to be considered especially in any patient presenting with kidney stones, bone disease, or hypercalcemic crisis. Several studies have found excessive mortality in patients with HPT with most of the excess caused by cardiovascular disease. The largest study included 4461 patients and measured an increased mortality risk of 1.71 for men and 1.85 for women. […] Up to 10% of cases of primary HPT are hereditary forms. Recognition is important because management of many patients and their families may be affected. Hypercalcemia usually responds well to treatment with corticosteroids.

• #17 HSR25-202: Epidemiology and Outcomes of Ventricular Arrhythmias in Patients With Hypercalcemia of Malignancy: A Population-Based Study in: Journal of the National Comprehensive Cancer Network Volume 23 Issue 3.5 (2025)

  https://jnccn.org/view/journals/jnccn/23/3.5/article-HSR25-202.xml?print

  Hypercalcemia of malignancy (HCM) is a common and potentially fatal complication of certain cancers. […] This study examined the impact of VA on outcomes in HCM patients, addressing a critical gap in the literature. […] We identified 50,700 cancer patients with hypercalcemia admitted from 2018 to 2021. Among these 735 (1.4%) had concurrent VA. The mortality rates were 8.9% in the entire cohort and 25.2% in those with VA. […] Patients with HCM who develop VA face significantly higher odds of adverse outcomes, including increased mortality, longer hospital stays, and greater hospitalization charges.

• #18 Hypercalcemia | 5-Minute Pediatric Consult

  https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/618175/all/Hypercalcemia?q=Pancreatitis

  Hypercalcemia represents an elevation in ionized and total calcium concentrations. […] Less common than hypocalcemia […] Less common in children than in adults […] Adults: 90% caused by hyperparathyroidism (HPT) or malignancy […] Children: more diverse etiologies dependent on age of presentation.

• #19 The risk of cancer in primary care patients with hypercalcaemia: a cohort study using electronic records | British Journal of Cancer

  https://www.nature.com/articles/bjc2014433

  The risk of cancer with hypercalcaemia in primary care is unknown. […] Hypercalcaemia was strongly associated with cancer, especially in males: OR 2.92, 95% CI 2.17-3.93, P=0.001; positive predictive value (PPV) 11.5%; females: OR 1.86, 95% CI 1.39-2.50, P=0.001: PPV 4.1%. […] Hypercalcaemia is strongly associated with cancer in primary care, with men at most risk, despite hypercalcaemia being more common in women. […] This paper appears to be the first large primary care study to quantify the risk of cancer in patients with hypercalcaemia. […] The risk of malignancy correlated with the degree of hypercalcaemia, with significant differences between men and women (OR 2.14, P=0.001). […] In men, even mild hypercalcaemia (2.6-2.8 mmoll-1) conferred a risk of cancer in 1 year of 11.5%. […] Hypercalcaemia is known to be associated with cancer, but this study shows that often it can predate the diagnosis of cancer in primary care.

• #20 Case report: familial hypocalciuric hypercalcemia – AL-Ramdhan – AME Case Reports

  https://acr.amegroups.org/article/view/9136/html

  Familial hypocalciuric hypercalcemia (FHH) is a hypercalcemic syndrome that is usually characterized by uncomplicated hypercalcemia and normal longevity. […] FHH is a rare condition that is passed down in an autosomal dominant pattern that affects both men and women equally. Specific prevalence is not known but is estimated to be between 1 in 78,000 and 1 in 1,000, which is much lower than the prevalence of primary hyperparathyroidism (pHPT), which is 1 in 1,000. However, the true prevalence is likely to be higher because many individuals suffering from it are unaware of its presence. […] FHH is usually classified into three types. FHH type 1 is the most common, affecting almost more than 65% of patients. […] It is important to diagnose this condition, not just in the reporting patient but also in other family members, because surgery should not be performed in such patients. […] For differentiating pHPT from FHH, a combination of clinical suspicion, biochemical testing, and genetic analysis is performed, and the diagnosis can only be confirmed after the genetic test results.

• #21 Familial hypocalciuric hypercalcemia epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Familial_hypocalciuric_hypercalcemia_epidemiology_and_demographics

  There is insufficient evidence about the incidence of familial hypocalciuric hypercalcemia. […] The prevalence of FHH is estimated to be 0.78 in 100,000 hypercalcemia cases. […] Patients of all age groups may develop familial hypocalciuric hypercalcemia. […] There is incomplete evidence regarding the racial predilection to familial hypocalciuric hypercalcemia. […] Familial hypocalciuric hypercalcemia affects men and women equally.

• #22 Calcitriol-mediated hypercalcemia as an immune-related adverse event in a patient receiving nivolumab and ipilimumab for metastatic renal cell carcinoma, case report | BMC Urology | Full Text

  https://bmcurol.biomedcentral.com/articles/10.1186/s12894-021-00825-4

  Severe hypercalcemia is often associated with uncontrolled malignancy through several mechanisms. However, calcitriol-mediated hypercalcemia is a rare etiology for advanced solid tumors. […] Calcitriol-mediated hypercalcemia accounts for approximately 1% of cases of hypercalcemia in the setting of malignancy. […] This case suggests calcitriol-mediated hypercalcemia as a novel immune-related adverse event. […] We report the first-known case of calcitriol-mediated hypercalcemia associated with immunotherapy. […] Given these findings, it seems likely that this episode of calcitriol-mediated hypercalcemia was in relation to immune checkpoint blockade. […] In conclusion, we report a rare case of calcitriol-mediated hypercalcemia as a novel immunotherapy-related adverse event in the absence of granulomas.

• #23 Hypercalcemia: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14597-hypercalcemia

  Hypercalcemia affects approximately 1% to 2% of the general population. Most of the cases about 90% are due to primary hyperparathyroidism and cancer-related hypercalcemia (hypercalcemia of malignancy). […] Hypercalcemia is a fairly common finding on routine blood tests such as a comprehensive metabolic panel (CMP) or basic metabolic panel (BMP), which include a calcium blood test. These tests allow healthcare providers to detect abnormally high calcium levels early. […] If you have symptoms of hypercalcemia or are at risk for developing hypercalcemia due to having a certain kind of cancer, your provider will order different blood tests to determine if you have hypercalcemia. If your blood calcium level is elevated, your provider will review your medications and medical history and conduct a physical exam. […] Prognosis, like treatment, depends on the cause and severity of hypercalcemia. When hypercalcemia happens due to a benign condition or temporary situation, it generally has a good prognosis.

• #24 Hypercalcemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430714/

  The prognosis of hypercalcemia is largely dependent on its etiology. Many processes causing hypercalcemia are benign and have simple treatment options that lead to a good prognosis, such as medication-induced hypercalcemia and primary hyperparathyroidism. When hypercalcemia is due to malignancy or granulomatous disorders, the prognosis may be very poor. Therefore, this is another reason why not only diagnosing hypercalcemia but also determining its etiology is crucial for its proper management.

• #25 Hypercalcemia – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/hypercalcemia/

  Hypercalcemia may be due to PTH-mediated or non-PTH-mediated causes. Primary hyperparathyroidism and malignancy are the most common causes, accounting for 90% of all cases. […] Severe or symptomatic hypercalcemia is a medical emergency. Treatment should be initiated immediately, in parallel with diagnostic workup. […] Measurement of serum intact PTH level is the key initial study for confirmed hypercalcemia with no immediately evident etiology. […] The clinical presentation is variable and ranges from asymptomatic presentation in mild hypercalcemia to life-threatening clinical features in severe hypercalcemia. See Classification of hypercalcemia. […] Laboratory values and the presence of symptoms should be used in conjunction to determine the need for treatment. Acutely symptomatic moderate hypercalcemia and severe hypercalcemia are medical emergencies and require hospital admission and immediate initiation of treatment.

• #26 Epidemiology, clinical features, and management of severe hypercalcemia in critically ill patients | SRLF

  https://www.srlf.org/article-revue/epidemiology-clinical-features-and-management-severe-hypercalcemia-critically-ill

  Severe hypercalcemia (HCM) is a common reason for admission in intensive-care unit (ICU). This case series aims to describe the clinical and biological features, etiologies, treatments, and outcome associated with severe HCM. This study included all patients with a total calcemia above 12 mg/dL (3 mmol/L) admitted in two ICUs from January 2007 to February 2017. […] 131 patients with HCM were included. HCM was related to hematologic malignancy in 58 (44.3%), solid tumors in 29 (22.1%), endocrinopathies in 16 (12.2%), and other causes in 28 (21.3%) patients. ICU and Hospital mortality rates were, respectively, 9.9% and 21.3%. HCM is associated with high mortality rates, mainly due to underlying malignancies. Early ICU admission and prompt HCM management are crucial, especially in patients with an underlying solid tumor presenting with neurological symptoms. […] The course of HCM may be complicated by organ failures which are most of the time reversible with early ICU management.

• #27 Challenging the dogma that severe hypercalcemia is life threatening

  https://acutecaretesting.org/en/journal-scans/challenging-the-dogma-that-severe-hypercalcemia-is-life-threatening

  Of the 1977 hypercalcemic patients, just 31 (1.56 % or 0.025 % of the total study population) had severe hypercalcemia (defined for the study as calcium 4.0 mmol/L). This first finding confirms the rarity of severe hypercalcemia; just 31 cases at this hospital emergency department during the 5-year study period. […] The primary aim was to determine the prevalence of life-threatening cardiac arrhythmias and/or life-threatening neurological complication (coma) during stay in emergency department among these 31 patients. […] ECG review confirmed that no patient presented with a life-threatening arrhythmia (i.e. no evidence of ventricular tachycardia, ventricular fibrillation, sinus arrest, second degree or third degree atrioventricular blocks). […] This study, which the authors claim is the first to specifically investigate the immediate threat posed by severe hypercalcemia, has revealed no evidence that the condition results in immediate life-threatening cardiac arrhythmia or coma. The cause of death among this study cohort could be justifiably attributed to factors other than severe hypercalcemia.

• #28 Epidemiology, clinical features, and management of severe hypercalcemia in critically ill patients | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0606-8

  These rates are far lower than usually reported in patients with onco-hematological malignancies hospitalized in ICU. […] Our study has several limitations. […] Prospective studies are needed to finely evaluate the existence of a threshold of HCM beyond which hospitalization in intensive care is necessary or to identify the most effective treatments.

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