Hypercalcemia without Hypercalcuria or Hypophosphatemia, Calcinosis and Renal Insufficiency

Hypercalcaemia in association with trisomy 21 (Down's syndrome)

“…3 Our patient was known to consume large volumes of milk but had no antacid treatment prescribed. The diagnosis of classic milk-alkali syndrome is unlikely in our patient 4 ; first, because of the absence of metabolic alkalosis, although this may be attenuated by impaired renal function and, second, because of the absence of other associated biochemical abnormalities, including hypokalaemia, hyperphosphataemia, and raised alkaline phosphatase. Finally hypercalciuria is absent in most cases of milk-alkali syndrome because alkalosis compromises urinary calcium excretion.…”

Fuller Albright

“…In 1949, Albright reported several patients with the chronic form of the milk alkali syndrome. These patients had chronic renal failure, hypercalcemia, soft tissue calcium deposits, band keratopathy, and nephrocalcinosis from the chronic ingestion of calcium-containing antacids (17). In 1953, Albright reported 35 patients with idiopathic hypercalciuria associated with kidney stones, hypophosphatemia, and normal serum calcium values (18).…”

Milk Alkali Syndrome and the Dynamics of Calcium Homeostasis

“…Moreover, the milk alkali syndrome could be differentiated from primary hyperparathyroidism because of the absence of hypophosphatemia and the resolution of the hypercalcemia once treatment with antacids was stopped. In 1949, Burnett et al (7) described a chronic variant of the milk alkali syndrome in which renal failure was persistent and soft tissue calcifications were extensive.…”

“…Patients often complained of pruritus and diffuse musculoskeletal symptoms. Nephrocalcinosis and band keratopathy were observed frequently, as were large soft tissue calcium deposits (7,10). Although symptoms usually improved with discontinuation of calcium antacids, resolution of hypercalcemia was slow, especially in patients with large soft tissue deposits of calcium.…”

“…In vitro studies have shown that metabolic alkalosis favors the influx of calcium to bone (109,110). Even though Burnett et al (7) and Rifkind et al (111) reported patients who had milk alkali syndrome and had osteosclerosis by x-ray, the capacity to increase bone mass with calcium supplementation may be age dependent and applicable primarily to children and adolescents (33)(34)(35)(36). Several observations suggest that alkali therapy can prevent bone loss in the elderly.…”