Childhood Sustained Hypercalcemia: A Diagnostic Challenge

Abstract

Objective:This study aimed to call attention to hypercalcemia, a rare finding in children which carries the potential of leading to serious complications without proper intervention.Methods:Diagnosis, treatment, and clinical course of children with sustained hypercalcemia admitted between the years 2006-2016 were reviewed. Group 1 [parathyroid hormone (PTH)-dependent] consisted of patients with high/unsuppressed PTH levels and group 2 (PTH-independent) included cases with normal/suppressed PTH levels.Results:Twenty patients (11 male, 9 female) with a median age of 6.25 (0.03-17.88) years were evaluated. Symptoms were mostly related with the gastrointestinal system, while six patients (30%) were asymptomatic. Physical examination findings were diverse, non-specific, and normal in four patients (20%). Median time of diagnosis was 45 (2-720) days. Patients were divided into group 1 (n=7) and group 2 (n=13). Most frequent etiologies were primary hyperparathyroidism (n=5), idiopathic infantile hypercalcemia (IIH) (n=5), and malignancy (n=4). A moderate positive correlation was noted between serum calcium and creatinine levels (r=0.53, p=0.02). Nephrocalcinosis was the most common complication (n=9) (45%). Treatment was not implemented in 2 patients with mild hypercalcemia, while other patients received medical treatment ± surgery. Treatment-resistant patients were cases of malignancies and neonatal severe hyperparathyroidism. Long-term follow-up displayed resistant hypercalciuria in three infants diagnosed as IIH.Conclusion:Many patients with childhood hypercalcemia are asymptomatic or exhibit a non-specific and heterogeneous clinical presentation, resulting in delayed diagnosis. Mild cases may not be recognized, while symptoms may be missed in the presence of accompanying illnesses. Nevertheless, serious complications may only be avoided with prompt diagnosis and intervention.

Calcium, Phosphate, and Vitamin D in Children and Adolescents with Chronic Diseases: A Cross-Sectional Study

“…In this study, there were no patients with hypercalcemic symptoms of hypotonia, poor nutrition, vomiting, constipation, abdominal pain, lethargy, growth retardation, polyuria, dehydration, and seizures [108]. Hypercalcemia is a more infrequent finding in children than adults [105] and no patients had serum Ca levels > 11 mg/dL [109], the highest cut-off point for many authors to identify hypercalcemic children [30]. Moreover, although Vit-D intoxication is another cause of hypercalcemia in childhood [109], in our study, only two out of eleven patients with Vit-D levels in the range of 30-85 ng/mL had hypercalcemia (Figure 3).…”

Magnesium Status and Ca/Mg Ratios in a Series of Children and Adolescents with Chronic Diseases

“…Fasting venous blood samples were collected to determine the serum level of Ca and Mg by standardized methods. The following cut-off points were used for serum Ca in children (8.8–10.8 mg/dL or 2.2–2.6 mmol/L) [ 55 ] and hypercalcemia (>11 mg/dL or 2.7 mmol/L) [ 56 ], for Mg: symptomatic hypomagnesemia (<1.22 mg/dL or 0.50 mmol/L), asymptomatic hypomagnesemia (1.22–1.82 mg/dL or 0.50–0.75 mmol/L), chronic latent Mg deficiency (CLMD: 1.82–2.07 mg/dL or 0.75–0.85 mmol/L), interval for health (2.07–2.32 mg/dL or 0.85–0.95 mmol/L), asymptomatic hypermagnesemia (2.32–4.86 mg/dL or 0.95–2.00 mmol/L), symptomatic hypermagnesemia (>4.86 mg/dL or 2.00 mmol/L) [ 57 ]. If the serum albumin level was <4.0 g/dL, serum Ca was corrected using the following formula: Ca corrected (mg/dL) = measured Ca (mg/dL) + [4 − albumin (g/dL)] [ 58 ].…”

Calcium, Phosphorus, and Vitamin D Levels in a Series of Cystic Fibrosis Patients: A Cross-Sectional Study

“…For serum evaluations, the following cut-off points were used: Vit-D in children: severe deficiency <5 ng/mL, deficiency < 20 ng/mL, insufficiency 20-30 mg/mL, sufficiency >30 ng/mL [137,138]; in adults: adequate for bone health >20 ng/mL, inadequate <20 ng/mL, <12 ng/mL insufficient, >50 ng/mL high levels [47]. Serum Ca in children: 8.8-10.8 mg/dL; in adults: 8.4-10.6 mg/dL [139]; and hypercalcemia >11 mg/dL [140]. Serum Ca was corrected when the serum albumin level was <4.0 g/dL, using the formula: Corrected Ca (mg/dL) = Measured Ca (mg/dL) + [4 − albumin (g/dL) [141].…”