High Calcium Levels

[tam200]

I was having high blood pressure problems starting about four years ago. My doctor put me on a dieuretic (water pill) along with my blood pressure medicine. I also have a GERD and take a stomach pill and eat a lot of tums. I have been running a high serum calcium level for several years now. I have had the following reading on serum calcium from 2007 to 2009. 10.5, 12.9, 10.9, 10.7, 11.0, 11.4, 10.6. I have had one PTH level done about a week ago and it was 46. I just had an ionized calcium level done and it was 5.7. I had a parathyroid ultrasound done last week and it did not show any parathyroid problems. I had a chest xray done and a test for sarcoidosis, it was negative. I have blood work out now to check for multiple myeloma. I discontinued the dieuretic last week and went on a dairy free diet per my doctor's orders. I asked him if this could be a parathyroid problem and he said no. He thinks it is being caused by the dieuretic. He is referring me to an endocrinologist. What do my doctor is on the right track?

[Mark Lupo, M.D.]

You likely have primary hyperparathyroidism.  The calcium can be increased slightly by HCTZ (the diuretic) but with this history and labs you likely have primary hyperparathyroidism and the ultrasound was not able to find the adenoma (about 75% are identifiable on ultrasound).

The PTH is inappropriately normal for this degree of elevated calcium.

[Mark Lupo, M.D.]

If myeloma were the cause of the high calcium, the PTH would usually be <20.
It is possible to have both MGUS (or myelom) and hyperparathyroidism.

[tam200]

Dr. Lupo,

Thank you so much for your response to High Calcium Levels posted by tam200 on Feb. 25, 2009. I have some new information since my posting. My primary doctor sent me to a Oncologist/Hemotologist. He said there was a monoclonal protein in my blood. He mentioned the IgG protein. The Hemotologist said he is working me up for multiple myeloma. He took more blood work and had a bone scan done. I ask him about the PTH level being 46 with the high calcium levels. He just said that the parathyroid was not the cause of the high calcium. He said the best case scenerio would be MGUS. I guess my question is twofold. First, even though I have this monoclonal protein would it still be possible for the parathyroid to be causing the high calcium levels? Second, If it was the monoclonal protein or myeloma causing the high calcium levels wouldn't the PTH level be very low?