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Treatments and drugs
By Mayo Clinic staffIf you have severe hypercalcemia, you may need to be hospitalized to reduce calcium to a safe level and protect your kidneys and bones. If so, hypercalcemia treatment may include:
- Intravenous fluids to rehydrate you
- Loop diuretic medications (such as furosemide) to help flush excess calcium from your system and keep your kidneys functioning
- Intravenous bisphosphonates, a group of drugs that includes pamidronate (Aredia) and zolendronate (Zometa), to inhibit bone breakdown
- Calcitonin, a hormone produced by your thyroid gland, to reduce bone reabsorption and slow bone loss
- Glucocorticoids (corticosteroids), to help counter the effects of too much vitamin D in your blood caused by hypercalcemia
- Hemodialysis to remove excess waste and calcium from your blood if your kidneys are impaired and you don't respond to other treatments
Once your blood calcium returns to a safe level, treatment for hypercalcemia depends on the underlying cause.
Primary hyperparathyroidism
If your hypercalcemia is mild, you and your doctor may choose to watch and wait, monitoring your bones and kidneys over time to be sure they remain healthy. If you've already lost bone mass or developed kidney stones, your doctor may recommend surgery to remove the affected parathyroid gland or glands (parathyroidectomy), which cures the condition in most cases. If you're not a good candidate for surgery, your doctor may recommend medication.
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Surgery. Traditionally, surgery has involved a noticeable incision, exploration on both sides of the neck and general anesthesia. But a newer technique, known as minimally invasive radioguided parathyroidectomy, may offer an easier option for some people. In this procedure, doctors use a radioisotope scan (sestamibi scan) to help locate the abnormal parathyroid gland before surgery. For the scan, you're given a small dose of a radioactive material that's absorbed only by the overactive parathyroid gland — not by healthy ones. During the operation, the surgeon uses the sestamibi scan results as a map to locate the abnormal gland. In some cases, a probe that detects radioactivity is used to confirm the location.
All surgery poses some risks. A small number of people undergoing parathyroid surgery experience damage to the nerves controlling their vocal cords, and some develop chronically low calcium levels, requiring treatment with calcium and vitamin D. In addition, although it's usually very effective, parathyroid surgery won't cure the problem in every case.
- Medication. The drug cinacalcet (Sensipar), which has been shown to lower calcium levels in the blood by reducing production of parathyroid hormone, may be effective for some people with hyperparathyroidism. If you've developed osteoporosis, taking medications called bisphosphonates, alendronate (Fosamax), risedronate (Actonel) or ibandronate (Boniva), can preserve bone mass in your spine and hip, reducing your risk of fractures.
Cancer
The decision of whether and how to treat hypercalcemia caused by cancer depends on the overall cancer treatment goals you've established with your doctor. Relieving the signs and symptoms of hypercalcemia may involve intravenous fluids for dehydration and medication such as bisphosphonates or other drugs to stop the breakdown of bone.
Treatment of hypercalcemia may reduce pain, improve quality of life, and enable you to remain active and undergo cancer treatments.
- Disorders of calcium concentration. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec12/ch156/ch156g.html. Accessed April 11, 2009.
- Agus ZS. Etiology of hypercalcemia. http://www.uptodate.com/home/index.html. Accessed April 10, 2009.
- Hypercalcemia (PDQ) health professional version. National Cancer Institute. Accessed April 11, 2009.
- Dietary supplement fact sheet: Calcium. Office of Dietary Supplements http://ods.od.nih.gov/factsheets/calcium.asp. Accessed March 8, 2009.
- Carroll MF. A practical approach to hypercalcemia. American Family Physician. 2003; 67: 1959.
- Bergson EJ. Sestamibi scans and intraoperative parathyroid hormone measurement in the treatment of primary hyperparathyroidism. Archives of Otolaryngology, Head and Neck Surgery. 2004; 130:87.
- Hyperparathyroidism. National Institute of Diabetes and Digestive and Kidney Diseases. http://endocrine.niddk.nih.gov/pubs/hyper/hyper.htm. Accessed April 14, 2009.
- Agus ZS. Treatment of hypercalcemia. http://www.uptodate.com/home/index.html. Accessed April 10, 2009.
- Nippoldt, TB (expert opinion). Mayo Clinic. Rochester, Minn. April 20, 2009.
