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13 January 2022 : Review article  

[In Press] A Review of Current Clinical Concepts in the Pathophysiology, Etiology, Diagnosis, and Management of Hypercalcemia

Carolina Rodrigues Tonon1ABCDEF, Taline Alisson Artemis Lazzarin Silva1ABCDEF, Filipe Welson Leal Pereira1ABDE, Diego Aparecido Rios Queiroz1ABDE, Edson Luiz Favero Junior1BD, Danilo Martins ORCID logo1E, Paula Schimdt Azevedo1ABE, Marina Politi Okoshi1ABCDEFG, Leonardo Antonio Mamede Zornoff1DE, Sergio Alberto Rupp de Paiva ORCID logo1CDE, Marcos Ferreira Minicucci1ACDE, Bertha Furlan Polegato1ABCDEFG

DOI: 10.12659/MSM.935821

Med Sci Monit In Press; DOI: 10.12659/MSM.935821  

Available online: 2022-01-13, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

ABSTRACT
Calcium is the most abundant extracellular cation in the body, and it is responsible for structural and enzymatic functions. Calcium homeostasis is regulated by 3 factors: calcitonin, vitamin D, and parathyroid hormone (PTH). Hypercalcemia is defined by a serum calcium concentration >10.5 mg/dL, and it is classified into mild, moderate, and severe, depending on calcium values. Most cases are caused by primary hyperparathyroidism and malignancies. Various mechanisms are involved in the pathophysiology of hypercalcemia, such as excessive PTH production, production of parathyroid hormone-related protein (PTHrp), bone metastasis, extrarenal activation of vitamin D, and ectopic PTH secretion. The initial approach is similar in most cases, but a definitive treatment depends on etiology, that is why etiological investigation is mandatory in all cases. The majority of patients are asymptomatic and diagnosed during routine exams; only a small percentage of patients present with severe manifestations which can affect neurological, muscular, gastrointestinal, renal, and cardiovascular systems. Clinical manifestations are related to calcium levels, with higher values leading to more pronounced symptoms. Critically ill patients should receive treatment as soon as diagnosis is made. Initial treatment involves vigorous intravenous hydration and drugs to reduce bone resorption such as bisphosphonates and, more recently, denosumab, in refractory cases; also, corticosteroids and calcitonin can be used in specific cases. This review aims to provide a clinical update on current concepts of the pathophysiology of calcium homeostasis, epidemiology, screening, clinical presentation, diagnosis, and management of hypercalcemia.

Keywords: Calcium; Diphosphonates; Humoral Hypercalcemia Of Malignancy; Hypercalcemia; Hyperparathyroidism

Editorial

01 January 2022 : Editorial  

Editorial: Current Status of Oral Antiviral Drug Treatments for SARS-CoV-2 Infection in Non-Hospitalized Patients

Dinah V. Parums
Science Editor, Medical Science Monitor, International Scientific Information, Inc., Melville, NY, USA

DOI: 10.12659/MSM.935952

Med Sci Monit 2022; 28:e935952

SARS-CoV-2/COVID-19

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Med Sci Monit In Press; DOI: 10.12659/MSM.935474  

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Evaluation of Structural Neural Connectivity Between the Primary Auditory Cortex and Cognition-Related Brai...

Med Sci Monit In Press; DOI: 10.12659/MSM.936131  

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Med Sci Monit In Press; DOI: 10.12659/MSM.935002  

25 Jan 2022 : Editorial  

Editorial: The 2022 World Health Organization (WHO) Priority Recommendations and Response to the Omicron Va...

Med Sci Monit In Press; DOI: 10.12659/MSM.936199  

25 Jan 2022 : Clinical Research  

Experience of the Polish Medical Air Rescue Service During the First Year of the COVID-19 Pandemic and Meas...

Med Sci Monit In Press; DOI: 10.12659/MSM.935474  

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750