| Autor: |
Tonon CR; Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil., Silva TAAL; Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil., Pereira FWL; Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil., Queiroz DAR; Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil., Junior ELF; Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil., Martins D; Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil., Azevedo PS; Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil., Okoshi MP; Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil., Zornoff LAM; Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil., de Paiva SAR; Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil., Minicucci MF; Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil., Polegato BF; Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil. |
| Abstrakt: |
Calcium is the most abundant extracellular cation in the body, and it is responsible for structural and enzymatic functions. Calcium homeostasis is regulated by 3 factors: calcitonin, vitamin D, and parathyroid hormone (PTH). Hypercalcemia is defined by a serum calcium concentration >10.5 mg/dL, and it is classified into mild, moderate, and severe, depending on calcium values. Most cases are caused by primary hyperparathyroidism and malignancies. Various mechanisms are involved in the pathophysiology of hypercalcemia, such as excessive PTH production, production of parathyroid hormone-related protein (PTHrp), bone metastasis, extrarenal activation of vitamin D, and ectopic PTH secretion. The initial approach is similar in most cases, but a definitive treatment depends on etiology, that is why etiological investigation is mandatory in all cases. The majority of patients are asymptomatic and diagnosed during routine exams; only a small percentage of patients present with severe manifestations which can affect neurological, muscular, gastrointestinal, renal, and cardiovascular systems. Clinical manifestations are related to calcium levels, with higher values leading to more pronounced symptoms. Critically ill patients should receive treatment as soon as diagnosis is made. Initial treatment involves vigorous intravenous hydration and drugs to reduce bone resorption such as bisphosphonates and, more recently, denosumab, in refractory cases; also, corticosteroids and calcitonin can be used in specific cases. This review aims to provide a clinical update on current concepts of the pathophysiology of calcium homeostasis, epidemiology, screening, clinical presentation, diagnosis, and management of hypercalcemia. |
