Q: I am a 66-year-old male 6’2”, 200 pounds, in good physical condition. I exercise five days a week, running and rowing. My meds are Lisinopril for high blood pressure, Lovastatin, Omeprazole and Tums for GERD, Mirtazapine and Xanax.
My concern is whether a serum calcium level of 10.5 mg/dL is too high. Is it a health problem at this level? If it is, can you comment on what some of the most common reasons for it might be?
A: Calcium is the most abundant mineral in the human body, vital for building strong bones and teeth, for blood clotting, heart health, releasing hormones, and numerous other functions. However, when levels are above normal, the condition is referred to as hypercalcemia. The primary causes for hypercalcemia are either over-activity in one or more of a person’s four parathyroid glands which are located behind the thyroid gland in the neck that are in charge of regulating blood calcium levels, or cancer. While uncommon, other conditions such as excessive use of vitamin D supplements and calcium, specific medications and other medical disorders may be to blame, such as decreased kidney excretion of calcium.
Specific forms of cancer, particularly lung and breast, as well as multiple myeloma (a cancer of the blood) increase a person’s risk for hypercalcemia. And, there are some malignant lesions that produce a protein that mimics parathyroid hormone, stimulating calcium to be released from bones into the bloodstream. This occurrence is referred to as paraneoplastic syndrome, the body’s response to cancer or to a substance the cancer produces.
Some medications, including thiazide diuretics and lithium prescribed for bipolar disorder are believed to increase the release of parathyroid hormone. Complications of hypercalcemia may include cardiac arrhythmias, kidney stones or failure, disorders of the nervous system, and osteoporosis. You indicate you take Tums which are calcium carbonate. This can raise your calcium level and lead to a condition called Milk-Alkali Syndrome. You should speak with your physician about your use of Tums and possibly consider an alternative.
Severe hypercalcemia in some patients may require hospitalization in an effort to protect the kidneys and bones. Treatment may include furosemide to help flush excesses from the system and keep the kidneys functioning, calcitonin to reduce bone reabsorption and slow bone loss, corticosteroids to balance an excess of vitamin D in the blood caused by hypercalcemia, IVs to replace lost fluids, and dialysis to remove excess calcium and waste from the blood in the event of kidney damage. Once levels return to normal, the underlying cause can be addressed. For example, a physician may choose to monitor the bones and kidneys if the signs and symptoms are mild. If bone loss has occurred or if an individual has developed kidney stones, a parathyroidectomy (removal of the affected parathyroid gland) may be appropriate, possibly utilizing a newer minimally invasive technique. In your case, if the Tums are to blame and you discontinue taking them, urgent treatment isn’t required. Lab values differ between facilities. In my opinion, your 10.5 reading is not cause for alarm.
You should return to your physician for an examination and testing to determine the cause for your elevated calcium level. Your dietary intake may be to blame, or supplements you once thought were good for you (such as vitamin A) may have to be eliminated. Excesses of A can cause hypercalcemia so work with your doctor to get the necessary answers.
Readers who would like related information can order Dr. Gott’s Health Report “The Thyroid Gland” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order payable to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
