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  • • Hypercalcemia due to hormonal product of nonparathyroid cancer

    • Most common cause of hypercalcemia in hospitalized patients

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Laboratory Findings

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  • • Low intact parathyroid hormone level

    • Elevated parathyroid hormone-related protein level

    • Anemia

    • Elevated serum calcium sometimes (to > 14 mg/dL)

    • Increased alkaline phosphatase activity

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  • • Most common tumors causing ectopic hyperparathyroidism are the following:

    • -Squamous cell carcinoma of the lung

      -Renal cell carcinoma

      -Bladder cancer

    • Less common offending tumors are the following:

    • -Hepatoma

      -Tumors of the ovary, stomach, pancreas, parotid gland, or colon

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Rule Out

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  • • Primary hyperparathyroidism

    • Familial Hypocalciuric Hypercalcemia (FHH)

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  • • History and physical exam

    • Laboratory evaluation

    • Search for primary malignancy

    • Elevated or non-suppressed PTH with elevated calcium implies primary hyperparathyroidism

    • Suppressed PTH implies normal parathyroid function; most common diagnosis is malignancy

    • Mild elevation of PTH and calcium can by FHH

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When to Admit

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  • • Hypercalcemic crisis

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  • • Treatment is directed at normalizing serum calcium level

    • Treatment of primary tumor treats malignancy-associated hypercalcemia

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References

Shepard MM. Smith JW 3rd. Hypercalcemia. American Journal of the Medical Sciences. 2007, 334(5):381-5.  [PubMed: 18004092]

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