High blood calcium may require surgery

ON CALL

December 24, 1991|By Dr. Simeon Margolis

Q: Tests done during an annual check up showed that my blood calcium level was too high. My doctor has told me that the results of further tests indicate that I have hyperparathyroidism and need an operation. I feel perfectly well and am therefore hesitant to undergo surgery. Could you explain the causes and effects of hyperparathyroidism and why surgery is necessary?

A: Hyperparathyroidism, one of many causes of a high blood calcium (hypercalcemia), is usually diagnosed by blood tests demonstrating elevated levels of both calcium and parathyroid hormone in the blood. This hormone is secreted by a small gland (parathyroid gland) in the neck and, under normal circumstances, maintains levels of blood calcium within the proper range. When overproduction of parathyroid hormone (hyperparathyroidism) occurs, more than 80 percent of the time it results from a small non-malignant tumor of the parathyroid gland. Only about 1 percent of the tumors of the parathyroid gland are malignant. Diffuse overgrowth of the cells of the gland is responsible for most of the other cases of hyperparathyroidism.

Parathyroid hormone causes release of calcium from the bones and also has several actions on the kidneys that tend to raise the blood calcium level. Thus, hyperparathyroidism causes hypercalcemia which, in turn, leads to increased thirst and urination, kidney stones, poor kidney function, nausea, vomiting, loss of appetite, constipation, peptic ulcer, weakness, high blood pressure and impaired concentration. With extreme hypercalcemia come lethargy, confusion and coma. In addition, the increased bone turnover can produce bone pain and fractures.

The only cure for hyperparathyroidism is surgical removal of the tumor or most of the gland if it is generally overactive. And surgery is recommended for patients whose hyperparathyroidism is causing any of the above symptoms. However, half or more of those with hyperparathyroidism, just like you, have no symptoms at all. Even then, surgery is recommended if: You are less than 50 years of age, your blood calcium levels are extremely high now or in the past, kidney function is impaired, urinary calcium excretion is markedly elevated, X-rays show kidney stones, or your bone mass is substantially reduced.

If none of these indications for surgery is present, medical follow up can be considered instead of surgery provided that both you and your doctor are committed to regular long-term monitoring for any evidence of worsening of the condition. You would also need to avoid excessive dietary calcium and certain types of diuretic pills as well as seek immediate medical attention with any illness that causes dehydration.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine and associate dean for faculty affairs at the school.

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