Disorders of calcium metabolism

Short description: Medical conditions

Disorders of calcium metabolism

Calcium
Specialty| Endocrinology

Disorders of calcium metabolism occur when the body has too little or too much calcium. The serum level of calcium is closely regulated within a fairly limited range in the human body. In a healthy physiology, extracellular calcium levels are maintained within a tight range through the actions of parathyroid hormone, vitamin D and the calcium sensing receptor.[1] Disorders in calcium metabolism can lead to hypocalcemia, decreased plasma levels of calcium or hypercalcemia, elevated plasma calcium levels.

## Contents

* 1 Hypocalcemia
* 2 Hypercalcemia
* 3 Plasma Calcium
* 4 See also
* 5 Notes
* 6 References
* 7 External links

## Hypocalcemia

Hypocalcemia (US English[lower-alpha 1]) or hypocalcaemia is common and can occur unnoticed with no symptoms or, in severe cases, can have dramatic symptoms and be life-threatening.[1] Hypocalcemia can be parathyroid related or vitamin D related. Parathyroid related hypocalcemia includes post-surgical hypoparathyroidism, inherited hypoparathyroidism, pseudohypoparathyroidism, and pseudo-pseudohypoparathyroidism.[1] Post-surgical hypoparathyroidism is the most common form, and can be temporary (due to suppression of tissue after removal of a malfunctioning gland) or permanent, if all parathyroid tissue has been removed.[1] Inherited hypoparathyroidism is rare and is due to a mutation in the calcium sensing receptor. Pseudohypoparathyroidism is maternally inherited and is categorized by hypocalcemia and hyperphosphatemia. Finally, pseudo-pseudohypoparathyroidism is paternally inherited. Patients display normal parathyroid hormone action in the kidney, but exhibit altered parathyroid hormone action in the bone.[1] Vitamin D related hypocalcemia may be associated with a lack of vitamin D in the diet, a lack of sufficient UV exposure, or disturbances in renal function. Low vitamin D in the body can lead to a lack of calcium absorption and secondary hyperparathyroidism (hypocalcemia and raised parathyroid hormone).[1] Symptoms of hypocalcemia include numbness in fingers and toes, muscle cramps, irritability, impaired mental capacity and muscle twitching.[1]

## Hypercalcemia

Hypercalcemia (US English[lower-alpha 1]) or hypercalcaemia is suspected to occur in approximately 1 in 500 adults in the general adult population.[2] Like hypocalcemia, hypercalcemia can be non-severe and present with no symptoms, or it may be severe, with life-threatening symptoms. Hypercalcemia is most commonly caused by hyperparathyroidism and by malignancy, and less commonly by vitamin D intoxication, familial hypocalciuric hypercalcemia and by sarcoidosis.[2] Hyperparathyroidism occurs most commonly in postmenopausal women. Hyperparathyroidism can be caused by a tumor, or adenoma, in the parathyroid gland or by increased levels of parathyroid hormone due to hypocalcemia.[2] Approximately 10% of individuals with cancer experience hypercalcemia due to malignancy.[2] Hypercalcemia occurs most commonly in breast cancer, lymphoma, prostate cancer, thyroid cancer, lung cancer, myeloma, and colon cancer.[2] It may be caused by secretion of parathyroid hormone-related peptide by the tumor (which has the same action as parathyroid hormone), or may be a result of direct invasion of the bone, causing calcium release.[2] Symptoms of hypercalcemia include anorexia, nausea, vomiting, constipation, abdominal pain, lethargy, depression, confusion, polyuria, polydipsia and generalized aches and pains.[2]

## Plasma Calcium

The amount of biologically active calcium varies with the level of serum albumin, a protein to which calcium is bound, and therefore levels of ionized calcium are better measures than a total calcium; however, one can correct a total calcium if the albumin level is known.[citation needed]

* A normal ionized calcium is 1.12-1.45 mmol/L (4.54-5.61 mg/dL).
* A normal total calcium is 2.2-2.6 mmol/L (9-10.5 mg/dl).
* Total calcium of less than 8.0 mg/dL is hypocalcaemia, with levels below 1.59 mmol/L (6 mg/dL) generally fatal.
* Total calcium of more than 10.6 mg/dL is hypercalcaemia, with levels over 3.753 mmol/L (15.12 mg/dL) generally fatal.

## See also

* Calcium metabolism
* Milk-alkali syndrome

## Notes

1. ↑ 1.0 1.1 see spelling differences between US and Commonwealth English

## References

1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Murphy, E; Williams (2009). "Hypocalcemia". Medicine 37 (9): 465–468. doi:10.1016/j.mpmed.2009.06.003.
2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Waters, M (2009). "Hypercalcemia". InnovAiT 2 (12): 698–701. doi:10.1093/innovait/inp143.

## External links

* "Hypocalcemia: updates in diagnosis and management for primary care". Can Fam Physician 58 (2): 158–62. February 2012. PMID 22439169.
* "Diagnosis and management of hypocalcaemia". BMJ 336 (7656): 1298–302. June 2008. doi:10.1136/bmj.39582.589433.BE. PMID 18535072.
* "Hypercalcemia. Pathophysiological aspects". Physiol Res 65 (1): 1–10. 2016. doi:10.33549/physiolres.933059. PMID 26596315.

Classification|

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Classification|

* ICD-10: E83.5
* ICD-9-CM: 275.4
* MeSH: D002128

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* v
* t
* e

Inborn error of metal metabolism (E83, 275)

Transition metal|

| Fe|

| excess:|

* Primary iron overload disorder: Hemochromatosis/HFE1
* Juvenile/HFE2
* HFE3
* African iron overload/HFE4
* Aceruloplasminemia
* Atransferrinemia
* Hemosiderosis

|

deficiency:|

* Iron deficiency

Cu|

| excess:|

* Copper toxicity
* Wilson's disease

|

deficiency:|

* Copper deficiency
* Menkes disease/Occipital horn syndrome

Zn|

| excess:|

* Zinc toxicity

|

deficiency:|

* Acrodermatitis enteropathica

Electrolyte|

| Na+ and K+|

* see Template:Water-electrolyte imbalance and acid-base imbalance

|

PO43−|

| excess:|

* Hyperphosphatemia

|

deficiency:|

* Hypophosphatemia
* alkaline phosphatase
* Hypophosphatasia

Mg2+|

| excess:|

* Hypermagnesemia

|

deficiency:|

* Hypomagnesemia

Ca2+|

| excess:|

* Hypercalcaemia
* Milk-alkali syndrome (Burnett's)
* Calcinosis (Calciphylaxis, Calcinosis cutis)
* Calcification (Metastatic calcification, Dystrophic calcification)
* Familial hypocalciuric hypercalcemia

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deficiency:|

* Hypocalcaemia
* Osteomalacia
* Pseudohypoparathyroidism (Albright's hereditary osteodystrophy)
* Pseudopseudohypoparathyroidism

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