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The parathyroid glands, which lie behind the thyroid, manufacture the parathyroid hormone, which plays a role in regulating your body's levels of the minerals calcium and phosphorus. Hypercalcemia is a condition in which the calcium level in your blood is above normal. Too much calcium in your blood can weaken your bones, create kidney stones, and interfere with how your heart and brain work.
Hypercalcemia is usually a result of overactive parathyroid glands. These four tiny glands are situated in the neck, near the thyroid gland. Other causes of hypercalcemia include cancer, certain other medical disorders, some medications, and taking too much of calcium and vitamin D supplements. Signs and symptoms of hypercalcemia range from nonexistent to severe. Treatment depends on the cause. Hypercalcemia can also cause neurological symptoms, such as depression , memory loss , and irritability.
Severe cases can cause confusion and coma. If you have cancer and experience any symptoms of hypercalcemia, call your doctor immediately. Your body uses the interaction between calcium, vitamin D , and parathyroid hormone PTH to regulate calcium levels.
PTH helps the body control how much calcium comes into the blood stream from the intestines , kidneys, and bones. Normally, PTH increases when the calcium level in your blood falls and decreases when your calcium level rises. Your body can also make calcitonin from the thyroid gland when your calcium level gets too high. The parathyroid glands are four small glands located behind the thyroid gland in the neck.
They control the production of the parathyroid hormone, which in turn regulates calcium in the blood. Hyperparathyroidism occurs when one or more of your parathyroid glands becomes overly active and releases too much PTH.
This creates a calcium imbalance that the body cannot correct on its own. This is the leading cause of hypercalcemia, especially in women over 50 years old. Granulomatous diseases, such as tuberculosis and sarcoidosis , are lung diseases that can cause your vitamin D levels to rise. This causes more calcium absorption, which increases the calcium level in your blood. Some cancers, especially lung cancer , breast cancer , and blood cancers , can raise your risk for hypercalcemia.
Some medications, particularly diuretics , can produce hypercalcemia. They do this by causing severe fluid diuresis, which is a loss of body water, and an underexcretion of calcium. This leads to an excess concentration of calcium in the blood. Taking too much vitamin D or calcium in the form of supplements can raise your calcium level. Excessive use of calcium carbonate, found in common antacids like Tums and Rolaids, can also lead to high calcium levels.
High doses of these over-the-counter products are the third most common cause of hypercalcemia in the United States. This usually leads to mild cases of hypercalcemia. Dehydration causes your calcium level to rise due to the low amount of fluid you have in your blood. However, the severity greatly depends on your kidney function. PET-scan control performed at 6 months of treatment normalized. Thirty months later, she remains well on low dose prednisone and MMF.
To our best knowledge, 8 cases of life-threatening hypercalcemia revealing isolated acute sarcoid-like myositis, including our 3 cases, have been reported so far. Median age was All patients suffered severe hypercalcemia ranging from 3. In all cases, PET-scan was performed for malignancy screening and incidentally revealed the muscle disease. Muscle biopsy showed diffuse non-necrotizing granulomas in all cases. All patients received corticosteroids. Immunosuppressive drugs were prescribed in two cases.
All but one patient achieved rapid, complete, and sustained remission under treatment with a median follow-up of One patient died from acute congestive heart failure with autopsy revealing a disseminated giant cell granulomatous process affecting skeletal, cardiac, and gastrointestinal smooth muscle.
Accordingly, treatment with prednisone led to dramatic clinical improvement. Sarcoid macrophages have been reported to produce PTH-rp that may contribute to hypercalcemia as well. The nodular type of sarcoid muscle involvement is characterized by palpable nodules that do not lead to weakness or functional disability. The acute sarcoid myositis mimics the presentation of acute polymyositis with elevated CPK blood levels.
Sarcoid and Sarcoid-like Myositis: Differing Patterns 6 , 27 — A typical sarcoidosis presentation with uncommon locations to a single organ and no lung involvement is clearly challenging. Our series highlights the high diagnostic yield of PET-scan in such setting. In most cases, muscular involvement, despite its extensive pattern, was not clinically suspected because of unspecific symptoms and normal CPK.
Only PET-scan—that was performed to disclose underlying malignancy in a context of profound hypercalcemia—clearly pointed to a diffuse and active muscle inflammation. Moreover, PET-scan appeared useful for monitoring the treatment response. In conclusion, the isolated granulomatous myositis causing high calcitriol levels should be considered a separate entity, distinct from systemic sarcoidosis.
Severe hypercalcemia revealing a diffuse granulomatous disorder limited to muscles might be life threatening and appears highly steroid-sensitive. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors report no conflicts of interest. National Center for Biotechnology Information , U. Journal List Medicine Baltimore v. Medicine Baltimore. Published online Mar Author information Article notes Copyright and License information Disclaimer.
All rights reserved. This article has been cited by other articles in PMC. Ethical Statement Our study is a retrospective human non-interventional study. Open in a separate window. Literature Review To our best knowledge, 8 cases of life-threatening hypercalcemia revealing isolated acute sarcoid-like myositis, including our 3 cases, have been reported so far.
Silverstein A, Siltzbach LE. Muscle involvement in sarcoidosis. Asymptomatic, myositis, and myopathy. Arch Neurol ; 21 — Clinical characteristics of patients in a case control study of sarcoidosis.
Lancet ; — Acute sarcoid myositis with respiratory muscle involvement. Case report and review of the literature. Chest ; —
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