Table 1.

Symptoms of the hypercalcemic syndrome, organ manifestations of pHPT, and typical indications for other causes of hypercalcemiaa

Components of Hypercalcemic Syndrome
OrganDisturbance (Reversible)Resulting Symptom or ComplicationDestabilization to Hypercalcemic CrisisOrgan Manifestation of pHPTPathognomonic Findings for Other Hypercalcemic Diseases
apHPT, primary hyperparathyroidism; FHH, familial hypocalciuric hypercalcemia; EKG, electrocardiogram; EEG, electroencephalography.
KidneyHyposthenuria, hypercalciuria, sodium and potassium loss → hypokalemiaPolyuria, polydipsia, exsiccosis, muscle weakness, arrhythmiaOliguria, anuria, azotemiaNephrolithiasis (recurrent), nephrocalcinosisFHH: hypocalciuria
IntestineIncreased gastric acid secretion, pancreatic enzyme secretion, delayed intestinal transportLoss of appetite, nausea, vomiting, weight loss, constipationIncreasePeptic ulcer (recurrent), pancreatitis (calcifying), cholelithiasisHyperthyroidism: weight loss
Central nervous systemEndocrine psychologic syndrome, EEG changesWeakness, tiredness, loss of initiative, depression, dizziness, loss of appetiteSomnolence, coma
MusculatureIncreases in level of neuromuscular excitabilityMuscle weakness, weakened reflexesIncreaseHypercortisolism: Cushing myopathy
Cardiovascular systemECG: shortened QT timeArrhythmia (hypertension)Cardiac arrest (avoid digitalis)Rare calcinosisHyperthyroidism: tachycardia, hypertension (large amplitude)
SkeletonOsteoporosis, ostitis fibrosa cystica generalisata (von Recklinghausen)Malignancies: bone metastases
AnklesChondrocalcinosis (pseudogout)