Endocrine Abstracts

Background: Severe hypercalcemia, defined as a serum calcium concentration ≥ 3.5 mmol/l or > 3 mmol/l associated with symptoms and signs of acute calcium intoxication, is a rare but a potentially life threatening condition. The aim of this study was to assess clinical, paraclinical, etiological and therapeutic features of severe hypercalcemia and to determine its outcome.

Methods: It was a retrospective, descriptive and comparative study conducted in the department of internal medicine, Charles Nicolle hospital of Tunis, and including 32 patients with severe hypercalcemia (group 1) and 39 patients with non-severe hypercalcemia (group 2). Clinical, paraclinical, etiological and therapeutic characteristics were determined.

Results: Although demographic characteristics including age and gender were similar in both groups, an age ≤45 years was significantly associated with severe hypercalcemia (Hazard Ratio (HR) =4.69, P=0.02). This condition was identified with symptoms of hypercalcemia or a complication in 75% of cases (HR=5.35, P=0.001). Weakness (HR=5.04, P=0.01), anorexia (HR=2.7, P=0.04), nausea, vomiting and epigastric pain (HR=5.14, P=0.01), dehydration (HR=31.29, P<0.001) and renal failure (HR=4.26, P=0.01) were significantly associated with severe hypercalcemia. Its main etiologies were malignancy (43%), primary hyperparathyroidism (30%), medications (20%) and sarcoidosis (7%). The management of severe hypercalcemia involved both intensive medical and etiologic treatment. Saline rehydration, furosemide, calcitonin, bisphosphonate and hemodialysis were prescribed in 81%, 34%, 81%, 25%, 25%, 9% and 3% of cases, respectively. An immediate significant decrease of serum calcium level (P<0.001) was obtained in all patients with a normalization in 17% of cases. The mortality rate was 12% in group 1 and 13% in group 2. The severity of hypercalcemia was not a predictive factor of mortality in our study.

Conclusion: Severe hypercalcemia is a therapeutic emergency including various symptoms. This condition can occur in multiple etiologies. Therefore plasma calcium should be measured at the slightest suspicion in order to perform an immediate and optimal management.