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

Increased calcium in the blood - what could it be?

Theoretically, there are three most likely clinical problems that could cause elevated blood calcium levels. All possible reasons for calcium levels in the blood being higher than normal are quite serious.

The first cause of high blood calcium is primary hyperparathyroidism, a disease accompanied by the appearance of a tumor in one or more parathyroid glands (it would be more correct to say “parathyroid glands,” but the term “ parathyroid glands"very widespread). 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 sense the concentration of calcium in the blood plasma and, in accordance with the level of calcium, produce parathyroid hormone. The main effect 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 enhancing the absorption of calcium from primary urine in the kidneys and enhancing its absorption from the intestines). When a tumor occurs in the thyroid gland its cells stop sensing the concentration of calcium in the blood - it “seems” to them that there is no calcium in the blood, or that it is low. Tumor cells begin to uncontrollably produce parathyroid hormone, which sharply increases the breakdown of bone tissue and the release of calcium from it into the blood. As a result, in the laboratory we determine increased blood calcium and at the same time high level 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 a tendency to fractures, bone deformation, and decreased 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 elevated calcium– this is the breakdown of bone tissue due to the occurrence of metastases of a malignant tumor in it. Metastases have a so-called lytic effect, i.e. destroy bone tissue and release calcium salts from it, which enter the blood and lead to increased calcium levels 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.

The third possible cause of high calcium levels in the blood– development of neuroendocrine tumors that produce so-called PTH-like peptides. These tumors are most often located in the lungs, although their location can be very variable. The size of such tumors is usually small - from 4-5 mm to 1-2 cm. They “know how” to produce chains of amino acids, the sequence of which coincides with the active end of parathyroid hormone. Such peptides (they are called PTH-like because they are very similar in action to parathyroid hormone) cause a situation where 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?

There are two main types of calcium tests - a blood test for ionized calcium and blood test for total calcium. Total calcium includes “free”, ionized calcium not bound to proteins + calcium bound to blood proteins (primarily albumin). The concentration of total blood calcium may change due to changes in protein content in the blood. At the same time, biological effect It is not total calcium, but only that part of it that is not bound to proteins - this part is called ionized calcium. The ionized calcium blood test is more accurate than the total calcium test, but it is also more complex - not all laboratories are able to perform this test, 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, reveals low ionized blood calcium in almost all patients - and for years the laboratory does not want to correct this obvious laboratory error. But the consequence of such an error is tens of thousands of unnecessary additional studies performed on those patients who are “lucky” to receive such an incorrect analysis.

There are situations when ionized calcium is elevated, but total calcium is normal– in this case, it is the analysis for ionized calcium that should be “trusted” more. At the same time, in most cases, increased blood calcium is manifested in both analyzes at once - increased ionized calcium and at the same time increased total calcium.

Considering the importance of ensuring maximum accuracy of a blood test for calcium and the high “price” of its incorrect determination, the North-Western Endocrinology Center conducts a blood test for calcium using equipment from the Russian representative office of the German laboratory network LADR. To carry out calcium analysis, an automatic biochemical analysis Olympus AU-680 (Japan), providing maximum research accuracy and capable of performing up to 680 tests per hour. Daily checks of the analyzer, stable high quality its work and compliance by all center employees with standards for taking blood for calcium allow doctors Northwestern center endocrinology to be confident in the quality of the blood test for calcium performed by the center’s laboratory. Exactly if in the blood test performed by our center the calcium is high, it means that the calcium is really high.

If blood calcium is elevated, what should you 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 take some additional tests before meeting the doctor.

The standard examination of patients with elevated blood calcium includes the following blood tests:

Parathyroid hormone;

Calcitonin;

This is the minimum with which you can already come to a consultation with a doctor. It is clear that the doctor can 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 at the North-Western Endocrinology Center we almost insist on performing blood tests in the laboratory of our center- this is the only way we can be sure that there are no laboratory errors and that our reasoning about the possible causes of elevated calcium levels in the blood is correct. The ionic composition of blood in the laboratory of our center is studied using the Olympus AU-680 analyzer (Japan) already mentioned above, and a blood test for such important indicators, like parathyroid hormone and calcitonin, is performed by an automatic chemiluminescent immunoassay analyzer of the 3rd generation DiaSorin Liaison XL (Italy) - one of the best devices in the world for analyzing blood 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 endocrinologist surgeons of the North-Western Endocrinology Center perform independently– this is important for searching for possible tumors of the parathyroid glands, which we simply have to suspect in a patient if there is an increased level of calcium in the blood. Second important instrumental study that needs to be done for patients with elevated blood calcium levels is determination of bone tissue density,. Calcium in the blood does not increase on its own - it is “taken” from bone tissue, which releases calcium into the blood and, as a result, reduces its density, which can lead to fractures. Densitometry, as well as ultrasound thyroid gland, is performed independently by endocrinologists at the North-Western Endocrinology Center. This is also an important argument in favor of examination and treatment in a specialized center.

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

Blood calcium is elevated, other tests have been taken - how to decipher them?

Of course, deciphering the blood test is the prerogative of the attending endocrinologist, and self-study Your blood test may lead the patient to diagnostic errors, however, in this article we will provide some information about the possible results of a laboratory examination for elevated blood calcium. Use the information obtained with caution and remember that it is not a substitute for consultation with a medical specialist.

So, possible options laboratory results and their interpretation.

Blood calcium is increased, parathyroid hormone is increased, phosphorus is decreased, calcitonin is normal, calcium in daily urine is increased - most likely we're talking about about primary hyperparathyroidism and the presence of parathyroid adenoma. Additional examination is necessary using ultrasound of the thyroid gland and neck, scintigraphy of the parathyroid glands with technetril, and in some cases, computed tomography of the neck. Treated surgically (possible in a specialized center) 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 deficiency of vitamin D in the blood. It is treated by taking 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 the test 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- should be suspected neuroendocrine tumor, producing PTH-like peptides or forming lytic metastases in the bone. Examination and treatment depend on the type of tumor detected.

High calcium in the blood (usually slightly increased calcium is noted), parathyroid hormone is moderately increased, phosphorus is normal, calcitonin is normal, calcium concentration in daily urine is reduced - we can talk about a rare familial 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 impaired 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 unnecessary surgery to remove a non-existent parathyroid adenoma.

Ionized calcium is increased, total calcium is normal, parathyroid hormone is increased– we are usually talking about parathyroid adenoma.

Ionized calcium is elevated, total calcium is below normal– laboratory error must be excluded. The analysis should be re-taken in a specialized laboratory.

Ionized calcium in the blood is increased, parathyroid hormone is increased, calcitonin is increased– the patient should be suspected of having both a parathyroid adenoma and medullary thyroid cancer. Together, these two diseases indicate high probability the patient has type IIA multiple endocrine neoplasia syndrome - a rare hereditary pathology transmitted in the family and leading to the development of three dangerous tumors: medullary thyroid cancer, parathyroid adenomas (usually multiple), pheochromocytoma (adrenal tumor that produces adrenaline or norepinephrine). Urgent consultation with an endocrinologist or endocrinologist surgeon is required!

Calcium in the blood is elevated during the first test, I want to retake the test - what is the best way to do this?

If you want to check whether your blood calcium is really elevated and are going to take a repeat blood test, follow some important rules, which will help the second analysis to be as accurate as possible:

1. a 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 drugs with vitamin D and calcium) - cancel them at least 2-3 days before the repeat blood test; the entry of calcium from the drug into the blood can lead to an increased calcium level in the blood - of course, in this case a falsely elevated calcium is detected.

Where to turn if calcium in the blood is elevated?

The Russian leader in the treatment of hypercalcemia (this is what high levels of calcium in the blood are called in medical language) is the North-Western Center for Endocrinology. The center’s specialists carry out all stages of diagnosis and treatment of patients with hypercalcemia:

Laboratory examination;

Conducting an ultrasound of the thyroid gland and neck;

Additional imaging methods (parathyroid scintigraphy with technetril, contrast-enhanced computed tomography);

Drug treatment for secondary hyperparathyroidism and vitamin D deficiency;

Minimally invasive surgery when primary hyperparathyroidism is detected;

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

Our recommendation (and believe me, this recommendation is based on the experience of treating thousands and thousands of patients!) - in all cases when the patient’s blood calcium is elevated, contact a specialized center - the North-Western 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 carried out to all citizens Russian Federation free of charge under compulsory health insurance).

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

- Petrograd branch of the Endocrinology Center in St. Petersburg - Kronverksky Prospekt, building 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, building 27A, tel. 36-306, opening hours from 7.30 to 20.00, seven days a week.

Reception of patients who have calcium in the blood is increased, carried out by specialists from the North-Western Endocrinology Center:

	Sleptsov Ilya Valerievich Doctor of Medical Sciences, surgeon, endocrinologist, oncologist, ultrasound diagnostics specialist. Professor of the Department of Surgery with a course in endocrinology. He is the head of the Northwestern medical center, is a member of the European Thyroid Association, the European Association of Endocrine Surgeons, Russian Association endocrinologists
	Chinchuk Igor Konstantinovich Candidate of Medical Sciences, surgeon, endocrinologist, oncologist, ultrasound diagnostics specialist. Member of the European Thyroid Association, European Association of Endocrine Surgeons.
	Uspenskaya Anna Alekseevna
	Novokshonov Konstantin Yurievich Surgeon, endocrinologist, oncologist, ultrasound specialist. Member of the European Thyroid Association.
	Endocrinologist, ultrasound diagnostic specialist. Member of the European Thyroid Association, Russian Association of Endocrinologists.
	Isheiskaya Maria Sergeevna Endocrinologist, specialist in ultrasound diagnostics. Member of the Russian Association of Endocrinologists. The doctor’s personal website is 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 a lately detected and untreated disease that causes high calcium levels can in some cases even be fatal. Don't take risks - If you have elevated calcium levels in your blood, always consult a doctor.

• Parathyroid glands

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

• Vitamin D and parathyroid adenomas

  There is a relationship between the concentration of vitamin D in the blood and diseases of the parathyroid glands. close connection. Low level 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 neoplasm of a malignant nature, developing from 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 with their subsequent replacement big amount 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 hyperplasias in two or more organs endocrine system(usually in tumor process parathyroid glands are involved, along with which islet cell neoplasms of the pancreas and pituitary adenoma are found)

• Operations on the parathyroid glands

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

• Consultation with an endocrinologist

  Specialists at the Northwestern Endocrinology Center diagnose and treat diseases of the endocrine system. The center's endocrinologists base their work on the recommendations of the European Association of Endocrinologists and the American Association of Clinical Endocrinologists. Modern diagnostic and treatment technologies ensure optimal treatment results.

  Ultrasound of the neck

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

• Consultation with an endocrinologist surgeon

  An endocrinologist surgeon is a doctor specializing 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 - control technique electrical activity laryngeal nerves, providing mobility vocal cords, during the operation. During monitoring, the surgeon has the opportunity to evaluate the condition of the laryngeal nerves every second and change the surgical plan accordingly. Neuromonitoring can dramatically reduce the likelihood of developing voice disorders after surgery on the thyroid 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 the methods quantification bone density or 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 gender and age. Bone tissue density is the main indicator that determines bone strength and its resistance to mechanical load.

Since childhood, we have been told to eat more dairy products because they are rich in bone-healthy calcium. But this element is necessary not only for our skeleton, but also for blood, muscles, and nerve fibers. There are 2 forms of calcium: ionized and bound. Ionized calcium is not bound to proteins, so it circulates freely in the blood. A blood test for calcium plays a significant role in diagnosing the condition of the body. Thanks to its informative content, you can choose the correct dosage of medications. Based on its data, one can judge the metabolism minerals in organism.

Protein-bound calcium does not have such a significant effect on the body. This is the state of Ca at the time of transport.

What is calcium needed for?

Calcium is one of the essential elements human body. It influences the flow metabolic processes. Blood contains two fractions of this element - ionized and bound. The bound substance may include plasma proteins, citrates, and phosphates. This form of calcium makes up 55% of the total volume in the blood plasma. 40% of them are associated with protein, 15% are phosphorus and citrate.

It turns out that 45% of the blood plasma remains for active ionized calcium. In this state, calcium is capable of many things. Here is the list useful functions which it does:

Promotes growth and development of bone tissue;

Stimulates the secretion of a neurotransmitter, thereby improving the conductivity of nerve fibers, since without this substance the transmission of neural impulses throughout the body is impossible;

It is one of the elements involved in the process of blood clotting;

Stabilizes the enzyme activity of the body;

Affects the intensity of muscle and heart contractions;

Reduces the permeability of the walls of blood vessels, thereby protecting them from exposure harmful substances.

The level of ionized calcium in the blood is important for the body. This is where he tries to send him first. Therefore, if a person’s teeth begin to hurt or bones become brittle, this is a clear signal of mineral deficiency. By the way, calcium also plays an important role in regulating blood pressure. Another of its functions is to strengthen the immune system and activate most hormones and enzymes.

The bound form is less productive. Experts believe that deviations up or down are not always a symptom of a malfunction in the metabolic process.

A person should consume 850-1300 mg of calcium per day. The main thing is not to overdo it, since the upper limit is 2500 mg. However, there are cases when increased consumption of this element is justified. For example, in the blood of pregnant women, or during lactation. The body's need for calcium also increases in athletes.

What to do to provide the body with this essential microelement? You should add the following foods to your diet:

From cereals - this is buckwheat;

From fruits - oranges;

Dairy products;

Legumes;

Vitamin D helps absorb calcium. It is often prescribed by pediatricians for newborns and older children.

There are also foods that interfere with the absorption of ionized calcium. These include:

Palm oil. It is found in different products where you need to replace milk natural fat for various cheap ersatz;

Some types of animal fats;

Sweets that have an alkaline reaction. For example, some candies.

Norms for different age groups

Norm of ionized mineral for each age group its. The table below shows the numbers that an analysis for ionized calcium should show. Otherwise, the obtained value is considered a deviation from the norm.

In a child, ionized Ca is increased when compared with the adult category. This phenomenon is explained by the intensive growth of bones, which shows the body’s high need for this element. This situation lasts for children until they reach the age of 16.

During pregnancy;

During lactation;

When taking contraceptives.

Who should undergo the procedure?

Most often, knowing the level of total calcium in the blood is enough to assess the process of mineral metabolism, since the ratio of free (45%) and bound (55%) forms is constant. But any rule has its exceptions, and for some people this ratio is violated. Therefore, it is advisable to conduct another type of study - an analysis of ionized calcium.

Significant fluctuations in the content of calcium ions have certain symptoms:

Unstable heart rhythm. She either speeds up or slows down her pace;

Muscle spasms;

Impaired consciousness.

The following conditions may serve as indications for donating blood for testing:

Cancerous tumors;

Preparation before surgery;

Gastrointestinal diseases;

Convulsions;

Pathology of the kidneys and urinary tract;

Changes in the cardiovascular system;

Pain in muscles and bones;

Low levels of proteins in the blood (hypoproteinemia).

So if you fall into one of these categories, then do not delay with the study, as it will help you choose the right dosage necessary medicine and will make the course of therapy more effective.

Preparing and conducting analysis

In order for the result of the analysis of calcium levels to be normal and undistorted by various factors, it is necessary to prepare for it. Here is a small list of rules to follow:

Biomaterial is given on an empty stomach. The last meal should be 12 hours ago;

You can smoke 1 hour before visiting the laboratory;

Excluded and heavy loads before taking the analysis;

Many medications can help raise or lower calcium levels in the body. Therefore, 14 days before the test, you should refrain from taking them. Naturally, you should first consult with your doctor on this issue. If the doctor does not allow you to interrupt the course of treatment, then the study form will indicate the medications taken and their dosage.

To carry out the analysis they will take venous blood. Currently in medical practice Two methods are used to determine the level of free calcium:

1. For total calcium;
2. Directly to the ionized form.

The first method is less expensive and therefore available in almost any government laboratory. It is funded compulsory medical insurance policy. The second technique is more informative. It allows you not only to install accurate diagnosis, but also to develop an individual course of treatment.

Very an important condition is to conduct the study within 2 days after blood sampling. Otherwise, prolonged exposure to air may distort the results, increasing the reference value of calcium ions. So you will receive a form with the analysis results after 3 days.

The time of day when the biomaterial is taken for analysis also plays an important role. It is preferable to do the fence in the morning. If the biomaterial is taken in the evening, active calcium will most likely be higher than normal.

Reduced rate

If a patient’s level of calcium ions is low, the following symptoms indicate this:

With these symptoms, hypocalcemia is diagnosed. The reasons that caused this condition are different in nature:

Vitamin D deficiency;

Extensive burn injuries;

Lack of magnesium in the blood;

The period after surgery;

The intestines absorb calcium poorly;

Metabolic alkalosis (acid-base imbalance).

You should know that such a condition with an indicator of less than 0.7 mmol/l is critical and faces the possibility of death.

Increased rate. Hypercalcemia

Hypercalcemia is a disease in which there is elevated calcium in the blood. The test results in this case are more than 2.6 mmol/l. At this concentration, a calcium deposit forms in the vessels, liver and renal tissue, which makes them brittle. There is a high risk of developing heart failure. Hypercalcemia on early stage characterized by the following symptoms:

Nausea;

Lack of appetite;

Intensive kidney work;

Malignant neoplasms

In patients undergoing hospital treatment, the cause of hypercalcemia is most often various malignant neoplasms. Causes of increased calcium in the blood during malignant tumors are not the same, but the increased source of calcium entering the blood is almost always the resorption of bone matter.

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 osteitis fibrocystis, characteristic of severe hyperparathyroidism. They usually have clearly defined boundaries and often lead to pathological fractures.

Most common cause hypercalcemia with malignant formations solid tumors with bone metastases appear. 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 typical for a variety of squamous cell carcinomas, renal cell carcinomas, breast or ovarian cancers. Previously it was believed that this condition is caused by ectopic production of parathyroid hormone. However modern research indicate that malignant tumors extremely rarely produce true parathyroid hormone. Its level, with standard laboratory determination, turns out to be either suppressed or not detectable at all, despite the presence of hypophosphatemia, phosphaturia and an increase in nephrogenic cAMP in the urine. Parathyroid hormone-like peptide has recently been isolated from some forms of tumors associated with hypercalcemia without bone metastases. This peptide is significantly larger than the native parathyroid hormone molecule, but contains an N-terminal fragment of its chain, which binds to parathyroid hormone receptors in the bones and kidneys, imitating many of its hormonal effects. This parathyroid hormone-like peptide can currently be determined by standard laboratory kits. It is possible that there are other forms of the peptide associated with individual human tumors. There is also the possibility that some tumors (eg, lymphoma or leiomyoblastoma) abnormally synthesize active 1,25(OH)2-vitamin D3, leading to increased intestinal calcium absorption, causing increased blood calcium, although decreased blood levels of vitamin D are typical in malignant tumors. 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 the unregulated excess conversion of the low-active 25(OH)-vitamin Dg into the 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 can also occur with symptoms of moderate hypercalcemia. These include thyrotoxicosis, hypothyroidism, gynercorticism, hypocorticism, pheochromocytoma, acromegaly, excess somatotropin and prolactin. Moreover, if an excess of hormones acts mainly by stimulating the secretion of parathyroid hormone, then a lack of hormones leads to a decrease in the processes of mineralization of bone tissue. 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 during long-term use. Lithium also reduces the functional activity of thyrocytes, leading to hypothyroidism, which also involves other hormonal mechanisms of hypercalcemia. This effect of this element led to the release separate form primary hyperparathyroidism - lithium-induced hyperparathyroidism.

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

Iatrogenic causes

State long-term immobilization, especially complete, leads to hypercalcemia due to accelerated bone resorption. This not entirely explainable effect is associated with the absence of gravity and loads on the skeleton. An increase in calcium in the blood develops within 1-3 weeks after the onset bed rest due to orthopedic procedures (plaster, skeletal traction), spinal injuries or neurological disorders. With resumption physiological stress the state of calcium metabolism is normalized.

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

Hypervitaminosis D, as 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, which 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.

Idiopathic hypercalcemia of infants is the result of rare genetic disorders characterized by increased intestinal calcium absorption. An increase in calcium is associated with increased sensitivity of enterocyte receptors to vitamin D or vitamin D intoxication (usually through the body of a nursing mother taking vitamin supplements).

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

First of all, it should be taken into account that primary hyperparathyroidism is characterized by an inadequate increase in the level of parathyroid hormone in the blood (inappropriate for the increased or upper-normal level of extracellular calcium). A simultaneous increase in calcium and parathyroid hormone in the blood can be found in addition to primary hyperparathyroidism with tertiary hyperparathyroidism and familial hypocalcium-uric hypercalcemia. However, secondary and, accordingly, subsequent tertiary hyperparathyroidism have a long history and characteristic initial pathology. With familial hypocalciuric hypercalcemia, a decrease in calcium excretion in the urine, a familial nature of the disease, its early onset, and 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 natural suppression of the level of parathyroid hormone in the blood. In the case of humoral hypercalcemia in malignant tumors without bone metastases, a parathyroid hormone-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, it can be detected in the laboratory increased level 1,25(OH)2-vitamin D3 in the blood.

Other instrumental diagnostic methods make it possible to detect changes characteristic of primary hyperparathyroidism in the bones, kidneys, and parathyroid glands themselves, thereby helping to differentiate it from other types of hypercalcemia.

Asked by: Irina, St. Petersburg

Female gender

Age: 46

Chronic diseases: Arrhythmias - present from 1 week to a month, according to Holter - bradycardia, tachycardia, accelerated rhythm runs, single and paired supraventricular and ventricular ecstasystoles. The total number per day is 15600. ECHO - slight hyperplasia of the left ventricle. Migraine - with nausea, dizziness, headache, from 1 day to 5 days: MRI of the neck - 4 cysts, in a row from 0.1 to 0.45 mm, osteochondrosis. Gastritis, esophagitis - pain under the left rib, bloating, rare diarrhea, almost constant constipation. VSD

Hello, in the spring, elevated calcium in the blood was discovered for the first time - total 2.77, ionization. 1.42. In this regard, an ultrasound scan of the gland was performed and parathyroid hormone was tested twice. On ultrasound, the right fora and isthmus were removed in 1997, the parathyroid glands are not visualized. Parathyroid hormone was normal both times. I contacted an endocrinologist and received an answer - everything is fine! Now in Once again I'm worried about arrhythmias, I took tests again as directed by the doctor - ionis. 1.43, overall 2.75. I feel unwell, arrhythmias (extrasystole, bradycardia, paroxysm. Tachyhardia, jogging), stomach pain, constipation, aching joints, in the morning I get up as if broken (as if I had been digging potatoes for a week without straightening up), I began to feel very cold - I couldn’t warm myself for hours, depression, anxiety. TSH 1.2, ultrasound done as well abdominal cavity- normal, MRI of the brain - normal, gastroscopy of the stomach - normal, flux - normal, I do it once every six months, pelvic ultrasound - fibroids, mammogram - normal. I turned to the endocrinologist again - the answer was the same - everything is fine! Tell me, please, in all honey. The literature says that hypercalcemia is harmful to health and indicates one of the bad processes, including a tumor. Why is everything okay with me then and yet bad feeling and tests? I really don’t want to, relying on the experience of a doctor who says that everything is wonderful, to then find something fatally incurable a year later. I haven’t written yet that in general analysis blood - everything is normal, except for monocytes, they are 13.5% with the rest good performance, this also lasts almost a year.
From chronic diseases: gastritis, fatty liver hepatosis, hernia cervical region and lower back, cervical migraine with syndrome vertebral artery, glucose tolerance, high cholesterol(I compensate with liprimar up to 5.0), panic attacks (infrequent for 5 years)
Medicines: L-thyroxine 100 mg, taken daily since 1997, liprimar 10 mg - daily for 2 years, rare use of analgin and phenozepam to relieve migraines and PA (very rarely, about once every 2-3 months). I don’t have hypertension, I don’t take diuretics, I don’t take vitamins, I take Detrolex twice a year in courses. Diet - low fat, low carbohydrates, butter, sour cream, mayonnaise, nuts, etc. - I haven’t eaten at all for 20 years!
Thank you very much for your answer.

Calcium plays a role in the human body vital role, because this element performs a huge variety of physiological functions, is one of the main extracellular components involved in blood clotting processes. Everyone knows that calcium is essential for building a strong skeleton and teeth, but besides this, it is an indispensable assistant in the conduction of heart contractions and nerve impulses, as well as in the functioning of the endocrine glands.

The adult human body contains approximately 1.5 kg of calcium, and 99% of total number concentrated in bone tissue, and only 1% is present in the blood.

To determine the concentration of the element in the blood serum, a person undergoes a biochemical blood test for calcium. This study is necessary if a specialist suspects a disturbance in the level of Ca, which leads to various diseases and destabilization of many important processes in organism. In this article we will look at all the details regarding this analysis, what it is needed for, what the normal level of calcium in the blood should be, and what deviations may indicate.

Why do you need a blood calcium test?

To understand the whole point this study, it should be noted that calcium in the blood occurs in 3 states:

• in a free state, it is called ionized calcium;
• in combination with anions (lactate, phosphate, bicarbonate, etc.);
• in combination with proteins (usually albumin-whey protein).

Prerequisites for prescribing an analysis to determine Ca levels may be a suspicion of osteoporosis, as well as some pathological conditions musculoskeletal system. The analysis can also be prescribed for specific patient complaints of bone aches, muscle pain, excessive tooth decay or brittleness. nail plate, with frequent fractures of the limbs. A calcium test is also carried out before surgical operations.

Most often, an analysis is performed for total calcium in the blood and ionized calcium. The second option is more informative, since the element “in a bundle” does not affect the functionality in the body as much as free particles of this thing. Although a blood test for ionized calcium will be more expensive, determining its level will be a more reliable indicator in diagnosing various diseases.

Only a doctor with the appropriate level of qualification should decipher the test results. The specialist analyzes the patient’s condition, taking into account not only blood indicators, but also clinical picture, existing symptoms and medical history of the person.

Therefore, we can only consider the average statistical norms for calcium levels in the blood of healthy person.

When taking an analysis to determine general level Ca, the following values ​​are considered normal:

• for children from 0 to 12 months - 1.9-2.6 mmol/l;
• for children from one to 14 years old - 2.3-2.87 mmol/l;
• for adults - 2.2-2.55 mmol/l.

Standard values ​​for different age categories will vary slightly, but on average it is considered normal to range from 2.16 to 2.6 mmol per liter.

It should be noted that the level of calcium in the blood of women during pregnancy and lactation decreases, since part of the substance goes to the development of the bones of the fetus and child. But at the same time, the body’s need for this element increases, therefore daily norm calcium for pregnant and nursing mothers is very high and ranges from approximately 1000 to 1300 mg.

When ionized calcium in the blood is checked, the norm should be within the following limits:

• in babies under one year old - 1.03-1.37 mmol/l;
• in children under 16 years old - 129-1.31 mmol/l;
• in adults - 1.17-1.29 mmol/l.

The reasons for the level deviation must be identified, since too low or too high calcium in the blood entails certain pathological changes in organism. A repeat analysis may be prescribed to refute or confirm existing abnormalities, and then further examination, diagnosis and appropriate treatment measures will be prescribed.

Increased calcium in the blood, what does this mean?

The condition when an increase in the concentration of a trace element of more than 2.5-2.6 mmol/l is detected is called hypercalcemia. If calcium in the blood is significantly elevated, this should be a significant cause for concern. There are quite a few different conditions and pathologies in the body that provoke an increase in Ca levels.

Most likely following reasons increased calcium in the blood, all of them are quite dangerous for the body.

1. Primary hyperparathyroidism

The essence of the disease is the appearance of tumors on the parathyroid (or also called parathyroid) glands, which are responsible for stabilizing the level of calcium in the blood.

These glands are capable of detecting the concentration of calcium in the blood and, in case of deficiency of this element, releasing parathyroid hormone, which increases the level of calcium in the blood due to the destruction of bone tissue with the release of calcium or due to more intense absorption of calcium in the kidneys and from the intestines. When tumors appear on the glands, parathyroid hormone begins to be released, even if there is normal calcium content in the blood. Thus, the bone structures break down, releasing excess calcium into the blood.

1. Malignant neoplasms and other tumor diseases.

Any tumor formation significantly affects bone tissue, including the formation of cytotoxins. An increase in calcium in the blood in women often occurs with the development of cancer in the ovaries or mammary glands.

1. Excessive use products with high content Ca, as well as an excess of vitamin D in the body, which contributes to good absorption microelement leads to disruption of calcium metabolism, slows down its excretion and increases the content of the cation in the blood.

Total calcium in the blood can be elevated in the following pathologies:

• in acute renal failure;
• for gastrointestinal ailments, including low levels of gastric juice production;
• with spinal tuberculosis;
• when dehydrated;
• Ionized calcium may be increased even with a sedentary, sedentary lifestyle and prolonged immobilization (no load on the skeleton), usually this only applies to people old age, in infants this indicator usually increases as a result of genetic or hereditary abnormalities.

Symptoms of excess calcium in the body

Hypercalcemia may be asymptomatic, but the patient may exhibit some specific signs of this state, For example:

• headache;
• nausea or vomiting;
• constant feeling thirst;
• constipation;
• absent-mindedness, emotional instability, sometimes mental disorders up to hallucinations;
• with chronic hypercalcemia, the patient often has lumbar pain and stomach pain, swelling of the limbs, and problems with urination.

What is dangerous about increased calcium in the blood, and how to remove excess calcium from the body?

An excess of the mineral in question in the human body is often a consequence of prolonged intake of certain medicines, as well as the development of certain diseases. This fact should not be ignored.

The fact is that excess calcium is not excreted by the body. naturally, which means it will concentrate in the kidneys and subsequently provoke the development urolithiasis. Also, this chem. the microelement is able to settle on the walls of blood vessels, contributing to the development of stenosis and cardiovascular diseases. Muscles also suffer from hypercalcemia. IN advanced cases a person experiences mental and emotional disorders.

It should be noted that the question of how to lower calcium in the blood must be resolved by a highly qualified specialist. You can independently improve your condition and normalize the indicator; a person can only do so by changing his diet and lifestyle. Since calcium enters the body exclusively with food, first of all it is necessary to exclude or minimize the consumption of foods high in Ca, mainly:

• cheese, kefir and cottage cheese;
• sardine;
• wheat bread;
• halva;
• sesame and Sesame oil;
• almond;
• black chocolate.

Now you know the main purpose of calcium; its excess, as well as its deficiency, can harm the body, so maintaining calcium levels in the blood serum is important for health. But, it should be remembered that if deviations in the indicator are detected, the last word in making a diagnosis must necessarily remain with the specialist; only a doctor will help to find out the cause of this condition and suggest measures to normalize it.

Listen to yourself and take care of your health!