Clinical investigation and prognosis of hypercalsemia patients between 2014-2017 years in Dokuz Eylül University Hospital

Introduction and Aim: Hypercalcemia is an important electrolyte disorder and might be seen as the first finding of an occult disease. Although there are multiple diseases in differential diagnosis, primary hyperparathyroidism and malignancy induced hypercalcemia are the most common causes which constitute 80-90% of patients. The aim of this study is, to investigate the symptoms, diagnostic approaches, treatment, diagnosis and survival data of patients according to degree of hypercalcemia and also to compare the hospital data with literature and increase the awareness of hypercalcemia. Material and Method: Between July 2014 and June 2017, from patients with total calcium level 10.5 mg/dl and over, whose corrected calcium 11 mg/dl and above and aged 18 and older included to this study and their data were retrospectively reviewed. We retrospectively reviewed medical records between July 2014 and June 2017. We included the patients who are 18 years old and older with total calcium level equal or greater than 10.5 mg/dl and corrected calcium equal or greater than 11 mg/dl. Results: 516 patients were evaluated for hypercalcemia. 185 patients 35,9% had primary hyperparathyroidism, 175 patients 33,9% had malignancy induced hypercalcemia and 66 patients 12,8% were found to have drug induced hypercalcemia. The frequency of female patients in hyperparathyroidism and male patients in malignancy-induced hypercalcemia were found to be significantly higher. (p<0,001). The mean calcium level was 11,8±0,8mg/dl in patients with primary hyperparathyroidism, and 13,6±1,7mg/dl in patients with malignancy induced hypercalcemia. Of the patients with hyperparathyroidism, 93 patients 50,3% had parathyroidectomy and 89,7% of them had single adenomas. Multiple myeloma 27,4% was the most frequent malignancy induced hypercalcemia etiology, followed by lung cancer 18,9% and breast cancer 9,1%. In solid tumors, the most common diagnoses were squamous cell carcinoma in 22,6% and adenocarcinoma in 18,9% of the patients. There was a significant relationship between mortality and hypercalcemia severity, presence of malignancy-related hypercalcemia, hemodialysis treatment. (p<0,001 p<0,001 p=0,027 respectively) Conclution: If a patient has hypercalcemia, clinical clues about underlying diseases should be assessed. Patients medical treatment should be reviewed, because in our hospital, drug induced hypercalemia have been detected more frequent than other hospital based studies. Parathyroid hormone levels should be seen in all patients, whose hypercalcemia have been confirmed, even if they have malignancy, because parathyroid induced hypercalcemia is the most common cause in all patients. Primary hyperparathyroidism should be considered in female patients, who are asymptomatic or mildly symptomatic, aged 50 or above, have mild-modarate hypercalcemia. Malignancy induced hypercalcemia should be primarily considered in male patients older than 50 years old, who have severe hypercalcemia and marked symptoms according to our study. Multiple myeloma, lung and breast cancer are malignancies that need to be excluded first stage in patients whose preliminary diagnose are malignancy. It should also be considered that patients may have multiple causes together, such as malignancy, hyperparathyroidism and drug use.