Approach to the Child with Hypercalcaemia

Abstract

Hypercalcaemia is rare in children. In adulthood, the causes are most frequently malignancy and primary hyperparathyroidism. In children, however, the aetiologies are diverse and age specific, and many have an underlying genetic basis. Hypercalcaemia is a serious condition that frequently leads to end-organ damage. In order to provide the most appropriate treatment, a key part of the management pathway is to establish the correct diagnosis promptly. When considering a practical approach to hypercalcaemia in children, it is helpful to consider the causes of hypercalcaemia according to the accompanying levels of parathyroid hormone (PTH), indicating whether the causes are PTH dependent or PTH independent. This chapter reviews the recent advances in this area and presents a practical approach to the investigation and subsequent management of this condition.

Childhood Sustained Hypercalcemia: A Diagnostic Challenge

“…Its clinical features tend to be diverse, non-specific, and sometimes insignificant. Some patients may be asymptomatic, while hypercalcemia can cause serious end-organ damage such as neurological complications and kidney failure if not diagnosed and treated promptly ( 3 , 4 , 5 ).…”

“…Calcium balance is maintained by complex interplay between the parathyroid gland, bones, the intestine, and the kidneys ( 6 ). The principle regulators of this process are considered to be parathyroid hormone (PTH) and 1,25-dihyroxyvitamin D [1,25-(OH) 2- D 3 ] ( 3 ). The calcium-sensing receptor (CaSR), which is expressed mainly in the parathyroid gland and kidneys, plays a critical role in the sustainment of plasma calcium levels.…”

“…The calcium-sensing receptor (CaSR), which is expressed mainly in the parathyroid gland and kidneys, plays a critical role in the sustainment of plasma calcium levels. Increased ionized calcium levels activate CaSR which in turn acts to reduce PTH secretion ( 3 , 4 ). PTH is secreted at a rate inversely proportional to the circulating level of ionized calcium ( 7 ).…”

Two Different Causes of Paediatric Hypercalcaemia

“…H ypercalcaemia is defined as serum calcium (S-Ca) levels of >2.7 mmol/L, with S-Ca levels of >3.0 mmol/L requiring therapeutic intervention and those of >3.5 mmol/L considered life-threatening and requiring immediate action. [1][2][3][4] Treatment consists of ensuring adequate hydration and administering glucocorticoids, diuretics (i.e. furosemide) and bisphosphonates (e.g.…”

“…[1][2][3] Hypercalcaemia in childhood is rare and may have different origins, including vitamin D intoxication, hyperparathyroidism, hyperthyroidism, granulomatous disease, Williams-Beuren syndrome, calcium-sensing receptor mutations, Jansen's metaphyseal chondrodysplasia, hypophosphatasia, subcutaneous fat necrosis and humoral or osteolytic malignancy. [1][2][3] A complete evaluation of blood minerals together with assessments of serum alkaline phosphatase (S-ALP) activity and parathyroid hormone (S-PTH) levels usually helps to ensure the correct diagnosis. This case report describes two cases of paediatric hypercalcaemia arising from different causes, one case in an infant and the other in an adolescent girl.…”