hypercalcemia with low associated PTH

[caravan25]

I am a thirty-one year old male with no known disease. Three months ago, I underwent blood tests as part of a routine physical. I was found to have mildly elevated WBC count, and more significantly, elevated serum calcium (11.4). An intact parathyroid assay was obtained with low-normal results (just above the cut-off line: 13 pg/ml in a range of 12-65). Needless to say, my life has been totally fraught with fear and anxiety since those results came in, because all the articles and literature available online suggest that there are very few benign conditions which cause hypercalcemia when associated with low or low-normal PTH, and I appear to have no symptoms associated with these benign conditions. Meds/supplements ruled out. I have had blood sampled twice since then, with gradually decreasing serum calcium numbers (11.1 and 10.7 respectively, in a range of 8.5-10.6). However, I have been making an effort to lead a healthier, less sedentary lifestyle, including better hydration, and I am concerned that the lower numbers may only be a result of better hydration.



In addition, approximately one month ago, I noticed some blood in my sputum when coughing. I subsequently underwent CT of chest and abdomen (which my doctor had ordered before the second blood results in order to evaluate the hypercalcemia). There were no abnormalities. My doctor diagnosed chronic sinusitis as the cause of the blood. As of the second set of results, my doctor has concluded that my hypercalcemia is not a serious issue, though he encouraged me to seek a second opinion from an endocrinologist if I desired peace of mind. (And I have an appointment next week with one.)



During the first month of all this, I had no symptoms, but I have recently developed fasciculations in my lower legs, arms, lips and eyes. These seem to be brought on or intensified by anxiety, but I can not be certain. My joints- especially the knees- are intermittently achy, as well as slight and occasional back and neck pain. Additionally, I have experienced some slight, barely discernable tinnitus in one ear, frequent (but not daily) moderate nocturnal headaches, and slightly bloodshot eyes. Some of these, I know, can be attributed to my high level of stress and anxiety in the face of a possible malignancy, as well as my chronic sinusitis and allergies, but then again, I can’t be certain.



I am at my wit’s end. What is causing the hypercalcemia? I feel like I’m “waiting for cancer” to happen, and any symptom is a possible sign because of the statistical improbability of benign conditions causing hypercalcemia with associated low PTH. During my first test, my TSH level was in the normal range; 2.656. (I also have high cholesterol, and am overweight.) Does this eliminate the chance of a thyroid-related cause? Should I have head and neck scans done? Was the CT scan of chest/abdomen misleading?



Thank you

[Kevin Pho, MD]

With a normal thyroid test, it would be unlikely that thyroid disease is present.



The possible causes of a high calcium in the setting of low PTH would be cancer or vitamin D excess.  A vitamin D level can be obtained to help differentiate the two (elevated in vitamin D excess, decreased in cases of cancer).



Regarding cancer, at age 31, there are no routinely age-appropriate cancer tests.  However, with the blood in the sputum, a bronchoscopy can be considered if the bleeding continues.  If there is evidence of blood in the stool, a colonoscopy can be considered.   Blood in the urine can necessitate a prostate exam.



These options can be discussed with your personal physician.



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Kevin, M.D.

kevinmd_b

[caravan25]

No more blood in sputum, no blood in stool, urinalysis revealed no blood in urine.

[Jaylyn]

I read with great interst Caravan25's 2/9/06 post on this subject.  I too am very apprehensive due to slightly elevated calcium levels with unknown etiology.  My current levels have been as low as 10.4 (high normal) and several in the 10.6 and 10.7 arena. However, checking back on routine lab reports dating back to 2003, I see my serum calcium had been 10.9 at one point (2003).  It seems I go from high normal range to the slightly elevated range.  On most current labs where my reading was 10.4 (high normal), my iodized calcium level was 5.59 which was about .25 over the high end of norm (5.28).  I do have Hashimotos Thyroiditis but my TSH is controlled by meds and monitored, so I don't know if my thyroid condition can still have an affect on my blood calcium levels.  My doctor ordered a 24 hour urine, which was normal.  I have had repeated calcium checks, and most of the time they are slightly elevated in one fashion or another.

I have read that if you are well enough to be sitting at a computer and researching hypercalcemia, then you DON'T have cancer, because hypercalcemia is NOT how cancer is first detected...that  hypercalcemia only develops in cancer patients when the cancer is fairly advanced and the person is very ill from the cancer and they already know they have cancer.  However, I don't know if that information is exactly correct and the doctor's response on this issue indicates to me that maybe that info is not correct.

On the other hand, I find it very unusual that I have apparently had slightly elevated calcium for three years and no doctor has even mentioned it to me.

I have also researched parathyroid disease and most (not all) the writers on this subject say that this disease is characterized by higher than normal blood calcium AND "high" PTH.  Like the other poster, my PTH is NOT high.  It is 28 (12-65 normal range), and it consistently reads about 28.  So....does this mean I don't have parathyroid disease, OR can it still be parathyroid disease with one or more bad glands still producing PTH when it (they) shouldn't be producing any (because I have enough calcium in my system, so essentially the gland(s) should be dormant)??  I am so confused, and extremely worried!

The next thing I will do is get a parathryoid scan I guess, but oftentimes the techs don't do enough of these scans to be true experts and this can result in a false negative (at least this is what I have read per my research).  It just seems like I may never get an answer, and in the meantime the whole thing is causing me way too much stress!  

I do have osteopenia in left hip (T score -1.7), and I have what I have been told is bursitis in my left hip---gives me a lot of pain.  Could this really be pain from cancer at this site?  WOULD ROUTINE BLOOD