A Simplified Approach to the Management of Hypercalcemia

While patients with hypercalcemia can be treated with various treatment options including volume expansion, loop diuretics, calcitonin, bisphosphonate, sensipar; hypercalcemia can be resistant to these measures. In this report, we present two elderly patients with hypercalcemia resistant to traditional therapy. Both had parathyroid tumor. Early diagnosis could not be established. Both patients required hemodialysis. Hypercalcemia was controlled in the 74-year old who successfully underwent surgery with normalization of calcium level. The 79-year old was not considered a surgical candidate and was transitioned to hospice. Primary hyperparathyroidism is an important cause of hypercalcemia. In order to reduce morbidity and mortality, its diagnosis must be established earlier on. These case reports prepared with residents/junior faculty will benefit other trainees with the diagnosis and management of refractory hypercalcemia and highlight a teaching point that prompt diagnosis of primary hyperparathyroidism can have a major positive impact on the overall management of hypercalcemia.