The Changing Profile of Hypercalcemia in Hospital Populations

Hypercalcemia is a relatively common condition in hospitalized patients. Malignancy is still the most common etiology for hypercalcemia in hospitalized populations. Much insight has been gained into the pathogenesis of malignancy-associated hypercalcemia (MAHC) over the last three decades. The classical primary hyperparathyroidism (PHPT) used to be a severe debilitating disease, usually involving bones and kidneys, needing hospital-based management. However, over the past five decades in the Western world and one decade in the Eastern countries, more and more cases of asymptomatic PHPT are being diagnosed. This population is detected with mild hypercalcemia on routine biochemical screening without any overt clinical features. Overzealous correction of asymptomatic vitamin D deficiency has led to the emergence of another type of hypercalcemia, called vitamin D toxicosis. This is not uncommonly seen, especially in countries where megadoses of injectable vitamin D preparations are easily accessible. Hypercalcemia of advanced chronic liver disease (CLD), a poorly understood and uncommonly reported condition is usually seen in hospitals having large volume hepatological services. Hypercalcemia due to chronic infective granulomatous diseases (like tuberculosis) in underdeveloped nations and granulomatous reactions to cosmetic filling materials in developed nations contribute significantly to non-parathyroid group of hypercalcemia. In conclusion, the pattern of hypercalcemia in hospitalized patients has changed considerably over the last five decades. Clinicians should be aware of these changing patterns so that appropriate diagnosis and treatment can be offered to the patients.