Elevated calcium levels in the blood are symptoms. Blood calcium is increased, other tests have been passed - how to decipher them? Vitamin D and parathyroid adenomas

- one of the essential trace elements for the human body. Its normal blood level is required for the proper functioning of many internal organs. In some cases, there may be a lack of calcium, in others - an excess of a substance in the body.

In today's material, we will talk about the second phenomenon, considering the essence of hypercalcemia, its symptoms and danger in more detail. Interesting? Then be sure to read the article below to the end.

As mentioned above, calcium is one of the most important trace elements for human body. Numerous Scientific research proved that this substance is a kind of building material for the internal organs of a person and is involved in most biochemical processes at the cellular level.

The main value of calcium for the body is the formation and development of the skeleton with the maturation of a person, as well as maintaining its normal state throughout life. In addition to its integral participation in the creation of bones, the substance also stimulates the growth of dental tissue, nails and hairline.

Applied, but no less important functions calcium in the body is considered to be:

1. normalization of the general metabolism
2. allergy prevention
3. stabilization of the cardiovascular structures
4. fight against inflammatory processes
5. regulation of the central nervous system
6. participation in reactions preceding blood clotting
7. activation of the production of hormonal substances and enzymes
8. normalization of the psycho-emotional background of a person

The importance of calcium for the human body simply cannot be underestimated. In the early stages of a person's life, an excess or deficiency of a substance can provoke irreparable anomalies in the development of the skeleton, and at an older age - the development of the most dangerous pathologies.

Given this, all people are simply obliged to periodically check the level of calcium in the blood and, if necessary, normalize it. Otherwise, there will always be risks of the appearance of diseases of unknown origin.

Causes of hypercalcemia

The phenomenon of a stable increase in calcium in human blood is called "hypercalcemia". This condition of a person is rightfully considered pathological, therefore, it is unacceptable to ignore its presence. Initially, pathology can be determined by indirect evidence its manifestations, expressed in violation of the work of some body systems. However, to organize therapy and accurately confirm the diagnosis, biochemical blood tests are simply indispensable.

Calcium in the human body can be both in free form and in combination with other substances. In the process of examining patients, doctors take into account both types of calcium and determine the following norms for them:

• no more than 2.6 mmol per liter for total calcium (a substance that is in combination with other trace elements)
• no more than 1.3 mmol per liter for free calcium

Directly the degree of hypercalcemia is usually determined by the content of the free element in the blood. With a slight excess of the calcium level - no more than 2 mmol per liter, with an average - 2.5 mmol per liter, with a severe one - it is in an amount of 3 mmol per liter.

The development of hypercalcemia can be caused by many factors, expressed in wrong work any system of the body. Often the cause of the pathology is:

• malfunctions
• kidney problems
• cardiovascular pathologies
• diseases of a neurological nature
• oncological diseases of internal organs

In addition, long-term use of certain drugs can provoke an increase in calcium in the blood. An excess of "calcium" food in the diet rarely causes hypercalcemia. It is possible to finally identify the root cause of the problem only within the walls of the clinic by implementing specialized examinations. Given this, any person who detects hypercalcemia should not hesitate to contact a doctor, otherwise the appearance of complications of existing pathologies will only be a matter of time.

The main symptoms of an increased trace element

With the maximum guarantee, diagnosing hypercalcemia is possible only in the hospital, if you pass a certain set of examinations. Solely by the symptoms of the problem, its presence can only be suspected, but not diagnosed.

Typical signs of elevated calcium in the blood are as follows:

• increased headaches and dizziness
• increased dryness and other skin problems
• development of dental caries
• nail damage
• brittleness or excessive hair loss
• bone problems (for example, a violation of their density)
• increased weakness and decreased performance
• causeless convulsions
• prolonged bleeding from wounds or lesions of the gums, indicating problems with blood clotting
• manifestations of various cardiovascular pathologies
• vomiting and nausea
• frequent constipation and pain in the gastrointestinal tract
• kidney problems

The more complex the considered symptoms appear, the higher the risk that a person develops hypercalcemia. Its manifestations should not be ignored. Determine the exact cause of the problem in terms of modern medicine It is not difficult, so it is pointless to be afraid of visiting the clinic.

Possible complications of the problem

Hypercalcemia is one of the main factors in the accelerated leaching of calcium from the bone tissue of the human body. Development similar condition is extremely dangerous for any person, as it provokes malfunctions of many internal organs.

At first, hypercalcemia will not manifest itself clearly, proceeding in its acute form, however, with the transition of the disease to a chronic formation, the first complications should be expected.

Typical consequences of a long-term and untreated pathology are as follows:

1. cardiovascular pathologies (especially frequent cases with impaired heart rate in patients with hypercalcemia)
2. kidney problems, usually
3. development of chronic seizures and their associated complications
4. exacerbation of chronic diseases of the body
5. malfunction of internal organs (liver, brain, etc.)

In especially severe cases, hypercalcemia can provoke coma or death due to cardiac arrest in the patient. Taking into account such a high risk of an excess of calcium in the body, it is necessary to respond to it adequately and in a timely manner to eliminate the problem.

Medication to lower calcium levels

It is possible to start a profile decrease in the level of calcium in the blood only if its excess is confirmed by appropriate studies in the clinic. Under no circumstances should hypercalcemia detected solely on the basis of symptoms be treated. Such an approach not only will not give results, but can also cause complications of existing problems.

It is possible to reduce the level of calcium in the body if the root cause of its increase is known. By eliminating it and removing excess substances from the body, a person will be able to return to his usual standard of living. In the vast majority of cases, hypercalcemia is eliminated with the help of ordinary medicines. The list of required drugs is determined only by a professional doctor, who bases his choice on the examinations conducted by the patient.

As a rule, the drug course is based on the intake of:

• Means that can eliminate the root cause of an increased level of calcium in the blood (hormonal, cardiovascular and other types of medicines).
• Diuretic drugs that accelerate the removal of excess minerals from the body.

Medicines from the diuretic group should not be potent, since the expediency in taking them is usually small. Strong diuretics are used only according to the doctor's profile appointments and in the absence of kidney or heart problems in the patient.

Note! The above tactics for the treatment of hypercalcemia is used in cases where an increase in free calcium in the blood is observed in the range up to 2.9 mmol per liter. If the mineral level is more than 3 mmol per liter, hospitalization of the patient and monitoring of such in the hospital is required. Otherwise, the risks of developing the most dangerous complications are great.

Traditional medicine for hypercalcemia

Folk remedies for hypercalcemia cannot act as the basis of therapy, since even the most effective of them are simply not able to compete with medications in terms of effect. With this in mind, use the techniques traditional medicine should be used solely as an aid to the main course of therapy.

It is of paramount importance to take care of the three pillars of the treatment of hypercalcemia, namely:

1. Consumption a large number water for the period of getting rid of an excess of calcium in the body. The main requirement is low water hardness, since when it high rate the mineral will only enter the body, but not be excreted. tap water in pure form better not to use. The optimal solution is proven purchased water or purified by a filter. To enhance the effectiveness of the main course of medicines, it is enough to drink 2 to 3 liters of water daily.
2. Nutrition correction, which consists in the exclusion of calcium-rich foods from the diet. Such an adjustment is required only for the duration of therapy for hypercalcemia. You can find out about the mineral content in a particular food in special product guides. At a minimum, you should not abuse dairy products, herbs and cheeses.
3. Stabilization hormonal background due to systematic physical activity, refusals from bad habits and normalization of sleep. Probably, it is not necessary to talk about the importance of a proper lifestyle for the period of treatment of the disease. Here everything is so very clear.

With regard to specific folk remedies, then diuretic decoctions will be most effective in case of an overabundance. It is not necessary to abuse such drugs, especially with the systematic use of diuretics. The normal dosage of decoctions, which enhances the effect of drugs, is equal to a third of a glass of the finished product 2-3 times a day.

More information about the trace element and its functions can be found in the video:

Decoctions made from:

• rose hips (2-3 tablespoons per 1 liter of water)
• peppermint and lingonberries (4 tablespoons of plants per 1 liter of water)
• bearberry herbs and fennel seeds (2.5 tablespoons of plants per 1 liter of water)

Nettle leaves, parsley and similar greens should not be added to the marked herbs, as it contains more calcium and neutralizes the effect of taking ready-made decoctions.

Perhaps on this note, the most important information on the treatment of hypercalcemia has come to an end. As you can see, it is not so difficult to normalize elevated calcium in the blood. The main thing is a competent approach and timely organized treatment. We hope that the presented material was useful for you and gave answers to your questions. Health to you and successful therapy of all diseases!

Increased blood calcium- a symptom that should always be the reason for an in-depth examination, since the disorders underlying it can be really dangerous for the patient. If you have done an analysis, and your blood calcium is elevated, it is imperative to undergo a consultation with an endocrinologist, who will conduct an examination according to the currently established standards.

Increased calcium in the blood - what could it be?

Theoretically, there are three most likely clinical problems that can cause high blood calcium levels. All possible reasons that calcium in the blood is above normal are quite serious.

The first reason for high blood calcium- this is primary hyperparathyroidism, a disease accompanied by the appearance of a tumor in one or more parathyroid glands (it is more correct to say "parathyroid glands", but the term "parathyroid glands" is very common). The main task of the parathyroid glands in the body is to maintain normal level blood calcium. The cells of the parathyroid glands "know how" to feel the concentration of calcium in the blood plasma and, in accordance with the level of calcium, produce parathyroid hormone. The main action of parathyroid hormone is to increase the level of calcium in the blood (by destroying bone tissue and releasing calcium from it into the blood, as well as by increasing the absorption of calcium from the primary urine in the kidneys and increasing its absorption from the intestines). When a tumor occurs in a pair thyroid gland its cells cease to feel the concentration of calcium in the blood - they "seem" that there is no calcium in the blood, or it is low. Tumor cells begin to uncontrollably produce parathyroid hormone, which dramatically increases the breakdown of bone tissue and the release of calcium from it into the blood. As a result, in the laboratory we determine the increased blood calcium and at the same time a high level of parathyroid hormone. Most often, such changes are also accompanied by a decrease in the level of phosphorus in the blood and an increase in the level of calcium in the urine. The danger of the disease lies in a decrease in bone density with the appearance of a tendency to fractures, to bone deformities, and reduced growth. An increased level of calcium in the blood leads to the deposition of calcium salts in the walls of blood vessels and heart valves, which reduces their elasticity and increases the tendency to thrombosis, which means the risk of strokes and myocardial infarction.

The second possible cause of high calcium- this is the breakdown of bone tissue due to the occurrence of metastases in it of any malignant tumor. Metastases have a so-called lytic effect, i.e. destroy bone tissue and release calcium salts from it, which enter the bloodstream and lead to an increased content of calcium in the blood. In this case, calcium in the blood is increased, but at the same time the level of parathyroid hormone is within the normal range or at the lower limit of normal.

Third possible reason high content calcium in the blood- the development of neuroendocrine tumors that produce the so-called PTH-like peptides. These tumors are most often localized in the lungs, although their location can be very variable. The sizes of such tumors are usually small - from 4-5 mm to 1-2 cm. They "know how" to produce chains of amino acids, the sequence of which matches the active end of the parathyroid hormone. Similar peptides (they are called PTH-like, since they are very similar in their action to parathyroid hormone) cause a situation when calcium in the blood is elevated, but laboratory analyzers do not show an increase in parathyroid hormone levels in this case, since PTH-like peptides do not completely copy the parathyroid hormone molecule.

Blood test for calcium - which one is better to take?

There are two main types of calcium tests - a blood test for ionized calcium and a blood test for total calcium. Total calcium includes “free”, non-protein ionized calcium + calcium bound to blood proteins (primarily albumin). The concentration of total blood calcium may change, including due to changes in the protein content in the blood. At the same time, it is not total calcium that has a biological effect, but only that part of it that is not associated with proteins - this part is called ionized calcium. An ionized calcium blood test is more accurate than a total calcium test, but at the same time more complex - not all laboratories are able to perform this analysis, and if they do, not all do it accurately. There is an almost anecdotal situation when one of the largest laboratory networks in St. Petersburg "chronically", for years, detects low ionized blood calcium in almost all patients - and this obvious laboratory error has not been corrected in the laboratory for years. But the consequence of such an error is tens of thousands of unnecessary additional studies conducted by those patients who are “lucky” to receive such an incorrect analysis.

There are situations when ionized calcium is elevated, and total calcium is normal- in this case, more "trust" should be precisely the analysis for ionized calcium. At the same time, in most cases, increased blood calcium is manifested immediately in both analyzes - increased ionized calcium and at the same time increased total calcium.

Considering the importance of ensuring the maximum accuracy of a blood test for calcium and the high “price” of its incorrect determination, the North-West Endocrinology Center performs a blood test for calcium using the equipment of the Russian representative office of the German laboratory network LADR. Calcium analysis is carried out automatically. biochemical analysis Olympus AU-680 (Japan), which provides the maximum accuracy of the study and is capable of performing up to 680 tests per hour. Daily analyzer checks, stable high quality his work and the observance by all employees of the center of the standards for taking blood for calcium allow the doctors of the North-West Center of Endocrinology to be confident in the quality of the blood test for calcium performed by the laboratory of the center. Exactly if in the blood test performed by our center, calcium is high, it means that calcium is really high.

If blood calcium is elevated - what to do?

As we noted earlier, increased calcium is always a reason for additional examination and consultation with an endocrinologist. In order to come to an appointment with an endocrinologist "not empty-handed", it is better to pass some additional tests even before meeting with the doctor.

The standard for examining patients with elevated blood calcium includes the following blood tests:

parathormone;

Calcitonin;

This is the minimum with which you can already come to a consultation with a doctor. It is clear that the doctor may then prescribe additional research, however, the three blood tests listed above will help him navigate in which direction he should conduct a diagnostic search.

When consulting patients with endocrinologists of the North-West Endocrinology Center we almost insist on performing blood tests in the laboratory of our center- only in this way can we be sure that there are no laboratory errors and the correctness of our reasoning about the possible causes of increased calcium in the blood. The ionic composition of the blood in the laboratory of our center is studied using the Olympus AU-680 analyzer (Japan) already mentioned above, and the blood test for such important indicators as parathyroid hormone and calcitonin is performed by the 3rd generation automatic immunochemiluminescent analyzer DiaSorin Liaison XL (Italy) - one of the best devices in the world for a blood test for hormones and tumor markers.

Auto immunochemiluminescent 3rd generation analyzer DiaSorin Liaison XL (Italy)

Immunochemiluminescent 3rd generation analyzer allows you to identify situations where high calcium is combined with high parathyroid hormone

Endocrinologists and surgeons-endocrinologists of the North-West Endocrinology Center independently perform- this is important for the search for possible tumors of the parathyroid glands, which we, with an increased level of calcium in the blood, are simply obliged to suspect in a patient. The second important instrumental study that needs to be done in patients with increased level blood calcium is determination of bone density,. Calcium in the blood does not increase by itself - it is "taken" from the bone tissue, which gives calcium to the blood and, as a result, reduces its density, which can lead to fractures. Densitometry as well as ultrasound thyroid gland, is performed by endocrinologists of the North-West Endocrinology Center independently. This is also an important argument in favor of examination and treatment in a specialized center.

The third important argument to contact a specialized center in any case, if your blood calcium is elevated, is the opportunity to undergo any healing procedures within the walls of the same institution. Even during the examination, you will not only have high blood calcium, but it will also become clear that parathyroid hormone is elevated, and a parathyroid gland adenoma will be detected on the neck - its removal can also be effectively performed at the North-West Endocrinology Center. AT this moment our center is the undisputed leader in the treatment of patients with high blood calcium in Russia - every year, surgeons-endocrinologists of the center perform the removal of parathyroid adenomas in more than 300 patients. In terms of the number of operations on the parathyroid glands, our center is now in 3rd place in Europe.

Blood calcium is increased, other tests have been passed - how to decipher them?

Of course, deciphering a blood test is the prerogative of the attending endocrinologist, and independent study his blood test can lead the patient to diagnostic errors, however, in this article we will give some information about possible outcomes laboratory examination with increased blood calcium. Use the information obtained with caution and remember that it does not replace the advice of a medical specialist.

So, possible options laboratory results and their interpretation.

Blood calcium is increased, parathyroid hormone is increased, phosphorus is reduced, calcitonin is normal, calcium in daily urine is increased - most likely, we are talking about primary hyperparathyroidism and the presence of parathyroid adenoma. An additional examination is required using ultrasound of the thyroid gland and neck, scintigraphy of the parathyroid glands with technetrile, and in some cases computed tomography of the neck. It is treated surgically (in a specialized center it is possible endoscopic surgery through an incision about 2 cm long).

Parathyroid hormone is elevated, calcium is normal, phosphorus is normal, calcitonin is normal- with a high degree of probability we are talking about secondary hyperparathyroidism due to a banal vitamin D deficiency in the blood. It is treated with vitamin D and calcium. It is important to exclude a laboratory error associated with an underestimation of the level of ionized calcium in the blood (it is better to retake an analysis for ionized calcium in a specialized laboratory of the endocrinology center).

Calcium in the blood is increased, parathyroid hormone is normal, phosphorus is normal, calcitonin is normal- a neuroendocrine tumor producing PTH-like peptides or forming lytic bone metastases should be suspected. Examination and treatment depends on the type of tumor found.

High blood calcium (usually slightly elevated calcium is noted), parathyroid hormone is moderately elevated, phosphorus is normal, calcitonin is normal, calcium concentration is reduced in daily urine - we can talk about a rare family disease, the so-called familial benign hypocalciuric hypercalcemia. This disease is accompanied by a change in the sensitivity of cellular receptors to parathyroid hormone and a violation of calcium excretion in the urine. Does not require treatment and is not dangerous. Often, inexperienced doctors diagnose primary hyperparathyroidism in such cases and refer the patient to an unnecessary operation to remove a non-existent parathyroid adenoma.

Ionized calcium is increased, total calcium is normal, parathyroid hormone is increased- it is usually all the same about parathyroid adenoma.

Ionized calcium is elevated, total calcium is below normal– it is necessary to exclude laboratory error. The analysis should be retaken in a specialized laboratory.

Calcium ionized in the blood is increased, parathyroid hormone is increased, calcitonin is increased- the presence of both parathyroid adenoma and medullary thyroid cancer should be suspected in the patient. Together, these two diseases indicate a high probability of a patient having the syndrome of multiple endocrine neoplasia type IIA - a rare hereditary pathology transmitted in the family and leading to the development of three dangerous tumors: medullary thyroid cancer, parathyroid adenomas (often multiple), pheochromocytoma (tumors adrenal gland, which produces adrenaline or noradrenaline). An urgent consultation with an endocrinologist or an endocrinologist is required!

Calcium in the blood is increased during the first analysis, I want to retake the analysis - how best to do this?

If you want to check whether blood calcium is really elevated and are going to donate reanalysis blood - observe some important rules, which will help the second analysis to be as accurate as possible:

1. blood test should be taken only in a specialized laboratory using high-quality equipment;

2. a blood test must be taken only on an empty stomach;

3. if you are taking vitamin D or calcium supplements (or combination preparations with vitamin D and calcium), cancel them at least 2-3 days before the second blood test; the intake of calcium from the drug into the blood can lead to an increased content of calcium in the blood - of course, in this case, a falsely elevated calcium is detected.

Where to turn if the calcium in the blood is elevated?

The Russian leader in the treatment of hypercalcemia (this is how high calcium in the blood is called in medical language) is the North-West Endocrinology Center. The specialists of the center carry out all stages of diagnosis and treatment of patients with hypercalcemia:

Laboratory examination;

Ultrasound of the thyroid gland and neck;

Additional imaging methods (scintigraphy of the parathyroid glands with technetrile, computed tomography with contrast enhancement);

Drug treatment for secondary hyperparathyroidism and vitamin D deficiency;

Minimally invasive surgery when detecting primary hyperparathyroidism;

Extended and combined operations on the thyroid gland, parathyroid glands, adrenal glands in the syndrome of multiple endocrine neoplasia.

Our recommendation (and believe me - this recommendation is based on the experience of treating thousands and thousands of patients!) - in all cases when a patient has elevated blood calcium, contact a specialized center - the North-West Endocrinology Center. Even if you live in Kamchatka or Sochi, examination and treatment in a specialized institution will help you save time, money and health. We annually treat patients from almost all regions of Russia (it is important to consider that, if necessary, surgical treatment it will be held for all citizens Russian Federation free of charge under the compulsory health insurance policy).

To make an appointment for a blood test or a consultation with a specialist doctor (endocrinologist or endocrinologist surgeon - both specialists will suit you with high blood calcium) you need to call the center's branches in St. Petersburg or Vyborg:

- Petrograd branch of the Endocrinology Center in St. Petersburg - Kronverksky prospect, house 31, 200 meters to the left from the Gorkovskaya metro station, tel. 498-10-30, opening hours from 7.30 to 20.00, seven days a week;

- Primorsky branch of the Endocrinology Center in St. Petersburg - Primorsky district of St. Petersburg, st. Savushkina, 124, building 1, tel. 344-0-344, opening hours from 7.00 to 20.00, seven days a week;

- Vyborg branch of the Endocrinology Center– Vyborg, Pobedy Avenue, house 27A, tel. 36-306, opening hours from 7.30 to 20.00, seven days a week.

Admission of patients who elevated blood calcium, carried out by specialists of the North-West Center of Endocrinology:

	Sleptsov Ilya Valerievich MD, surgeon, endocrinologist, oncologist, specialist in ultrasound diagnostics. Professor of the Department of Surgery with a course of endocrinology. He is the head of the North-Western Medical Center, a member of the European Thyroid Association, the European Association of Endocrine Surgeons, the Russian Association of Endocrinologists
	Chinchuk Igor Konstantinovich Candidate of Medical Sciences, surgeon, endocrinologist, oncologist, specialist in ultrasound diagnostics. Member of the European Thyroid Association, European Association of Endocrine Surgeons.
	Uspenskaya Anna Alekseevna
	Novokshonov Konstantin Yurievich Surgeon, endocrinologist, oncologist, specialist in ultrasound diagnostics. Member of the European Thyroid Association.
	Endocrinologist, specialist in ultrasound diagnostics. Member of the European Thyroid Association, Russian Association of Endocrinologists.
	Isheyskaya Maria Sergeevna Endocrinologist, specialist in ultrasound diagnostics. Member of the Russian Association of Endocrinologists. Doctor's personal website - spb-endo.ru.

At the end of this article, it should be noted once again that a situation where calcium in the blood is elevated ALWAYS requires further examination and consultation endocrinologist. The consequences of an untimely detected and untreated disease that causes elevated calcium can, in some cases, even be fatal. Don't risk it - If you have high calcium levels in your blood, always consult your doctor..

• parathyroid glands

  general information about the parathyroid glands (location, number, function, history of discovery, major diseases, operations)

• Vitamin D and parathyroid adenomas

  Between the concentration of vitamin D in the blood and diseases of the parathyroid glands, there is a close relationship. A low level of vitamin D in the blood can lead to the development of secondary hyperparathyroidism, or to the appearance of parathyroid adenomas (primary hyperparathyroidism)

• Medullary thyroid cancer

  Medullary thyroid cancer (medullary thyroid carcinoma) is a rare hormonally active malignant neoplasm that develops from the parafollicular cells of the thyroid gland.

• Paget's disease

  Paget's disease or osteitis deformans is a chronic pathological condition of individual bones of the human skeleton, during which foci of increased decay of bone cells are formed, followed by their replacement with a large amount of defective bone tissue

• Multiple endocrine neoplasia syndrome type I (MEN-1 syndrome)

  Multiple endocrine neoplasia syndrome type 1, otherwise called Wermer's syndrome, is a combination of tumors or hyperplasia in two or more organs endocrine system(as a rule, the parathyroid glands are involved in the tumor process, along with which islet-cell neoplasms of the pancreas and pituitary adenoma are found)

• Operations on the parathyroid glands

  The Northwestern Center of Endocrinology and Endocrine Surgery performs operations to remove parathyroid gland adenomas for all types of hyperparathyroidism. More than 800 patients with this disease become our patients annually

• Endocrinologist's consultation

  Specialists of the North-Western Center of Endocrinology diagnose and treat diseases of the endocrine system. The endocrinologists of the center in their work are based on the recommendations of the European Association of Endocrinologists and the American Association of Clinical Endocrinologists. Modern diagnostic and therapeutic technologies provide optimal treatment results.

  neck ultrasound

  Information about the ultrasound of the neck - the studies included in it, their features

• Consultation with an endocrinologist

  An endocrinologist is a doctor who specializes in the treatment of diseases of the endocrine system that require the use of surgical techniques(surgical treatment, minimally invasive interventions)

• Intraoperative neuromonitoring

  Intraoperative neuromonitoring - a technique for monitoring electrical activity laryngeal nerves providing mobility vocal cords, during the operation. During monitoring, the surgeon has the opportunity to assess the condition of the laryngeal nerves every second and change the operation plan accordingly. Neuromonitorng can drastically reduce the likelihood of developing a voice disorder after surgery on the thyroid gland and parathyroid glands.

• Densitometry

  Densitometry is a method for determining the density of human bone tissue. The term "densitometry" (from the Latin densitas - density, metria - measurement) is applied to methods for the quantitative determination of bone density or its mineral mass. Bone density can be determined using X-ray or ultrasound densitometry. Data obtained during densitometry are processed using computer program, which compares the results with indicators accepted as the norm for people of the corresponding sex and age. Bone density is the main indicator that determines the strength of the bone, its resistance to mechanical stress.

Malignant neoplasms

In patients treated in a hospital, the cause of hypercalcemia is most often various malignant neoplasms. The reasons for the increase in calcium in the blood in malignant tumors are not the same, however, the resorption of bone substance is almost always an increased source of calcium in the blood.

Hematological tumor diseases - myeloma, some types of lymphomas and lymphosarcomas - act on bone tissue through the production of a special group of cytokines that stimulate osteoclasts, causing bone resorption, the formation of osteolytic changes or diffuse osteopenia. Such foci of osteolysis should be distinguished from fibrocystic osteitis, which is characteristic of severe hyperparathyroidism. They usually have well-defined boundaries, often leading to pathological fractures.

Most common cause hypercalcemia in malignant tumors are solid tumors with bone metastases. More than 50% of all cases of malignant-associated hypercalcemia are breast cancer with distant bone metastases. In such patients, osteoresorption occurs either due to local synthesis of osteoclast-activating cytokines or prostaglandins, or through direct destruction of bone tissue by a metastatic tumor. Such metastases are usually multiple and can be detected by radiography or scintigraphy).

In some cases, hypercalcemia occurs in patients with malignant tumors without bone metastases. This is characteristic of a variety of squamous cell carcinomas, renal cell carcinoma, breast or ovarian cancer. Previously, it was believed that this condition is caused by ectopic production of parathyroid hormone. However modern research indicate that malignant tumors rarely produce true parathyroid hormone. Its level in the standard laboratory determination is either suppressed or not detectable at all, despite the presence of hypophosphatemia, phosphaturia and an increase in nephrogenic cAMP in the urine. A parathyroid hormone-like peptide has recently been isolated from some forms of tumors associated with hypercalcemia without bone metastases. This peptide is much larger than the native parathyroid hormone molecule, but contains an N-terminal fragment of its chain, which binds to parathyroid hormone receptors in bones and kidneys, mimicking many of its hormonal effects. This parathyroid hormone-like peptide can currently be detected with standard laboratory kits. The presence of other forms of the peptide associated with individual tumors person. There is also the possibility that certain tumors (eg, lymphoma or leiomyoblastoma) abnormally synthesize active 1,25(OH)2-vitamin D3, resulting in increased intestinal absorption of calcium, causing an increase in blood calcium, although a decrease in blood vitamin D levels in malignant tumors is typical. solid tumors.

Sarcoidosis

Sarcoidosis is associated with hypercalcemia in 20% of cases, and with hypercalciuria in up to 40% of cases. These symptoms are also described in other granulomatous diseases such as tuberculosis, leprosy, berylliosis, histioplasmosis, coccidioidomycosis. The cause of hypercalcemia in these cases is apparently unregulated excess conversion of inactive 25(OH)-vitamin Dg to a powerful metabolite 1,25(OH)2D3 due to the expression of 1a-hydroxylase in granuloma mononuclear cells.

Endocrine diseases and increased calcium in the blood

Many endocrine diseases may also occur with symptoms of moderate hypercalcemia. These include thyrotoxicosis, hypothyroidism, gynercorticism, hypocorticism, pheochromocytoma, acromegaly, excess growth hormone and prolactin. Moreover, if an excess of hormones acts mainly by stimulating the secretion of parathyroid hormone, then their lack of hormones leads to a decrease in the processes of bone tissue mineralization. In addition, thyroid hormones and glucocorticoids have a direct osteoresorptive effect, stimulating the activity of osteoclasts, causing an increase in calcium in the blood.

Medications

Thiazide diuretics stimulate calcium reabsorption and thus increase blood calcium.

The effect of lithium preparations has not been fully elucidated. It is believed that lithium interacts both with calcium receptors, reducing their sensitivity, and directly with parathyroid cells, stimulating their hypertrophy and hyperplasia with prolonged use. Lithium also reduces the functional activity of thyrocytes, leading to hypothyroidism, which also activates other, hormonal, mechanisms of hypercalcemia. This effect of this element led to the isolation of a separate form of primary hyperparathyroidism - lithium-induced hyperparathyroidism.

The so-called milk-alkali syndrome (milk-alkali syndrome), associated with a massive intake of excess calcium and alkali from food, can lead to reversible hypercalcemia. As a rule, an increase in blood calcium is observed in patients who uncontrollably treat hyperacid gastritis or peptic ulcers with alkalizing drugs and fresh cow's milk. This can lead to metabolic alkalosis and kidney failure. The use of proton pump blockers and H2 blockers significantly reduced the likelihood of this condition. If milk-alkaline syndrome is suspected, one should not forget about the possible combination of peptic ulcer (with persistent severe course), gastrinoma, and primary hyperparathyroidism as part of a variant of MEN 1 syndrome or Zollinger-Ellison syndrome.

Iatrogenic causes

The state of prolonged immobilization, especially complete, leads to hypercalcemia due to accelerated bone resorption. This not quite explainable effect is associated with the absence of gravity and loads on the skeleton. An increase in calcium in the blood develops already 1-3 weeks after the start of bed rest due to orthopedic procedures (gypsum, skeletal traction), spinal injuries or neurological disorders. With the resumption of physiological stress, the state of calcium metabolism normalizes.

A number of iatrogenic causes include an overdose of vitamins D and A, long-term use of thiazide diuretics, and lithium preparations.

Hypervitaminosis D, as already mentioned above, causes hypercalcemia by enhancing calcium absorption in the intestine and stimulating osteoresorption in the presence of parathyroid hormone.

Hereditary diseases leading to hypercalcemia

Benign familial hypocalciuric hypercalcemia is an autosomal dominant hereditary pathology associated with a mutation of calcium-sensitive receptors that increases the threshold of their sensitivity. The disease manifests itself from birth, affects more than half of blood relatives and is mild, clinically insignificant. The syndrome is characterized by hypercalcemia (severe), hypocalciuria (less than 2 mmol / day), a reduced ratio of calcium clearance to creatinine clearance (less than 1%), moderately elevated or upper-normal levels of parathyroid hormone in the blood. Moderate diffuse hyperplasia of the parathyroid glands is sometimes observed.

Infantile idiopathic hypercalcemia is the result of a rare genetic disorder characterized by increased absorption of calcium from the intestine. An increase in calcium is associated with an increased sensitivity of enterocyte receptors to vitamin D or vitamin D intoxication (usually through the body of a nursing mother taking vitamin preparations).

Differential diagnosis of primary hyperparathyroidism and other hypercalcemia is often a serious clinical problem, but some fundamental provisions can sharply narrow the range of possible causes of pathology.

First of all, it should be borne in mind that primary hyperparathyroidism is characterized by an inadequate increase in the level of parathyroid hormone in the blood (inconsistent with an increased or upper-normal level of extracellular calcium). A simultaneous increase in calcium and parathyroid hormone in the blood can be detected in addition to primary hyperparathyroidism in tertiary hyperparathyroidism and familial hypocalcification, uric hypercalcemia. However, secondary and, accordingly, subsequent tertiary hyperparathyroidism have a long history and a characteristic initial pathology. With familial hypocalciuric hypercalcemia, a decrease in calcium excretion in the urine, a family nature of the disease, its early onset, a high level of calcium in the blood atypical for primary hyperparathyroidism with a slight increase in blood parathyroid hormone are noted.

Other forms of hypercalcemia, with the exception of the extremely rare ectopic secretion of parathyroid hormone by neuroendocrine tumors of other organs, are accompanied by a natural suppression of the level of parathyroid hormone in the blood. In the case of humoral hypercalcemia in malignant tumors without bone metastases, a parathormone-like peptide can be detected in the blood, while the level of native parathyroid hormone will be close to zero.

For a number of diseases associated with increased intestinal absorption of calcium, an elevated blood level of 1,25(OH)2-vitamin D3 can be detected in the laboratory.

Other Methods instrumental diagnostics make it possible to detect changes in the bones, kidneys, and parathyroid glands that are characteristic of primary hyperparathyroidism, thereby helping to differentiate it from other variants of hypercalcemia.

When conducting a biochemical blood test, the amount of ionized calcium is also checked, which shows the level of a trace element that is not bound to proteins. According to these indicators, it can detect hypocalcemia or hypercalcemia. These conditions are pathological and dangerous for human health, because calcium is involved in many vital processes in the body.

Show all

Analysis

Ionized calcium is a very important trace element in the regulation of metabolic processes. He makes up only 1% of the total amount of the mineral. Up to 99% of calcium is found in teeth, bones, hair, etc.

This trace element is responsible for the following functions:

• growth and development of bone tissue;
• blood clotting;
• conduction of nerve fibers;
• regulation of enzymatic activity;
• hormone production;
• contraction of muscle fibers and heart muscle.

Calcium ions help strengthen the walls of blood vessels, increase the body's resistance to infections and allergic irritants.

For these reasons, biochemical analysis for ionized calcium is one of the most common in medical institutions. The assessment of its level allows to clarify important information on mineral metabolism of both an adult and a child.

Indications

An analysis for the level of ionized calcium is established in the following cases:

• signs of deficiency or increased amount of calcium in the body;
• preoperative preparation;
• malignant tumors;
• diseases of the urinary system;
• convulsive manifestations;
• muscle and bone pain;
• pathologies of the cardiovascular system;
• decrease in protein levels in the blood.

If the patient is being treated with intravenous administration blood products and glucose-salt solutions, then the level of the mineral is monitored daily.



Rules for the delivery of biomaterial

To obtain a reliable result, you must comply with the basic requirements:

• exclude severe physical exercise before passing the analysis;
• for a day do not drink alcohol and fatty foods;
• do not smoke for an hour;
• do not eat for 12 hours (the analysis is taken on an empty stomach);
• do not donate biomaterial after instrumental methods of examination and physiotherapy procedures.

Various medications can affect the level of ionized calcium. Therefore, 1-2 weeks before the scheduled examination, it is recommended to stop taking medications. It is advisable to consult with your doctor about the abolition of drugs. If temporary cancellation is not possible, then when donating the biomaterial, the patient must indicate the medicine and in what doses he takes it.



What should be the Ca level?

When determining the normal level, the individual characteristics of the patient and many other factors are taken into account. However, averages can be indicated:

If its level is elevated, a second analysis is carried out, since the results may be the result of an incorrectly performed blood test. The content of ionized calcium can be affected by prolonged contact of the biomaterial with air. If re-analysis shows the same, then additional diagnostic procedures are carried out.

Increased rate

At increased amount calcium in the blood is diagnosed as hypercalcemia. This condition is dangerous because an excessive amount of this microelement settles on the walls of blood vessels, liver and kidneys. As a result, heart failure, a pathological condition of the liver and biliary tract, and urolithiasis can develop.

An increase in the level of ionized calcium in the blood can be recognized by the following symptoms:

• chronic nausea and vomiting;
• decrease in working capacity;
• feeling of thirst;
• convulsive syndrome;
• heart rhythm disturbance, shortness of breath;
• weakness.

To normalize the amount of trace elements in the blood, it is necessary to establish the causes of hypercalcemia. If it is provoked by malnutrition, then the diet is adjusted. In the case of any pathologies, it is urgent to start treating the underlying disease.

Reduced rate

A reduced level can be identified by the following clinical manifestations:

• slow blood clotting;
• destruction of nails and teeth;
• increased heart rate;
• brittle hair;
• nervous excitability;
• dry skin;
• headaches and muscle pain;
• dizziness;
• fractures even with minor injuries or stress.

Calcium deficiency is detrimental to the child during its development. For the formation of the spine and bones, this trace element is very important. With a deficiency in children, limbs may be bent, posture may be disturbed.

For successful treatment deficiency of this trace element should also identify the root cause. Typically, patients are given special diet or vitamin preparations.

Reasons for promotion and demotion

There are several main reasons why the level of ionized calcium can be elevated:

• oncological diseases;
• increased content of vitamin D;
• chronic enteritis - inflammation in small intestine(typical for children);
• increased content of growth hormone;
• endocrine diseases;
• metabolic disorders;
• abuse of products containing calcium.



Causes of hypercalcemia

Calcium deficiency can indicate certain pathologies in the body:

• kidney disease;
• lack of magnesium or vitamin D;
• diseases of the pancreas;
• infectious diseases;
• consequences of the operation;
• diseases of the gastrointestinal tract;
• endocrine diseases.

Often, low levels of ionized calcium are diagnosed after the age of 50 in women, in menopause. This is due to hormonal changes. Its deficiency often affects patients who abuse diets for weight loss. During pregnancy, there is also often a lack of this trace element. Calcium can be washed out of the body when taking diuretics or eating salty foods.

Treatment

When receiving the result of blood tests with a low or high level of ionized calcium, the diet is adjusted. In the diet, add or exclude from it, respectively, products containing this microelement.



Foods rich in calcium

Even with sufficient intake of food rich in this mineral, its absorption depends on vitamin D and magnesium. Therefore, it is necessary to simultaneously eat foods with their content.



Foods rich in magnesium

There are 4 ways to eliminate hypercalcemia:

• decreased absorption of the microelement by the intestines;
• increased excretion of calcium in urine;
• removal of excess by dialysis;
• reduction in bone destruction.

Drugs and treatment regimen are selected strictly individually by the doctor.

Certain illnesses can cause hypercalcemia, an elevated level of calcium in the blood, which can lead to other health problems over time. It is important to determine the causes of both excess and shortage of the element.

Elevated blood calcium levels are most common in patients with primary or tertiary hyperparathyroidism.

In most cases, the diagnosis reveals benign tumors(adenomas) on the parathyroid gland. The disease develops predominantly in the female half of the population and in those who have been treated radiation therapy in the neck area.

With oncology of the lungs, ovaries, kidneys, the resulting metastases can penetrate into the bone tissue and destroy it, thereby “freeing” calcium. Therefore, patients with malignant tumors have a high concentration of the mineral in the blood serum.

The development of hypercalcemia is caused hereditary pathologies(hypocalciuric hypercalcemia, endocrine neoplasia), granulomatous lesions (sarcoidosis, histoplasmosis,).

The reasons for the increased content of calcium in the body include the intake medicines containing lithium, theophylline, thiazide diuretics, thyroid hormones.

Prolonged lack of movement, for example, after fractures, burns, provokes an increase in calcium and resorption (destruction) of bone tissue.

The main causes of hypercalcemia are an excess of parathyroid hormone in the body (hyperparathyroidism), oncology and long-term use of calcium preparations.

Diagnostics

The level of calcium in the body is determined using a urinalysis and biochemical blood screening for electrolytes. Including investigated the amount of magnesium, sodium, phosphorus, chlorine and potassium.

With latent hypercalcemia (against the background low level protein) spend laboratory diagnostics plasma for free calcium. for free calcium is a more accurate indicator of the content of the mineral in the blood than a study of the total amount.