English summaries
Hypercalcaemia – how to proceed?
Julkaistu 18.06.2010 00.01
Primary hyperparathyroidism is the leading cause of hypercalcaemia, most often caused by a parathyroid adenoma. The incidence of hypercalcaemia in malignancy appears to be falling owing to the wide use of bisphosphonates in patients with multiple myeloma or breast cancer. In verified hypercalcaemia the first investigation is determination of the serum parathyroid hormone. If serum ionized calcium exceeds 1.55 mmol/l (fpCa > 3.0 mmol/l), the patient is in need of urgent fluid resuscitation. Furosemide is not routinely given in hypercalcaemic crisis but is helpful in fluid retention if the patient has cardiovascular or chronic kidney disease. Bisphosphonates are the cornerstone in treatment of hypercalcaemic crisis and in prevention and treatment of bone resorption and osteoporosis in the hypercalcaemic states. Intravenous bisphosphonates are the most efficient treatment in malignancy. In primary hyperparathyroidism the parathyroid adenoma should be surgically removed if the criteria for surgery are met. However, yearly follow-up visits are the treatment of choice for the majority of patients: for asymptomatic patients whose serum calcium remains stable and is only mildly elevated. Vitamin D deficiency should be avoided.
Päivi Hannula, M.D., Ph.D., Specialist in Internal Medicine, Tampere University Hospital, E-mail: paivi.hannula@pshp.fi
Finnish Medical Journal 2010;65:2193–7.
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