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

[jodydiver]

A related discussion, Very Low PTH but High Calcium was started.

[strohsmom]

A related discussion, Low PTH, High Calcium, Low vitamin D was started.

[Sandin]

Hi, I'm new to the forum- I was drawn to your post. I too have found parathyroid.com to be informational but my test results still have me confused. I have had several health issues since contracting the West Nile Virus in late 2002- but I seemed to be getting along great untill this past year and have been suffering from muscled fatigue, no energy, no appetite, all over pain like the flu- I have taken 2 mo. off from my job and have had a time with depression as I am only 41.
Can you help me with my labs?

Calcium-10.4
PHT-11.9
Ferritin-10.5
Alkaline Phosphatase-30
Platlets-378
Albumin- 4.4

i developed a lump under my right clavicle that swells when I get really rundown. I have had MRI and bone scan showing no dislocation or fracture.

Sed rate is 3
CPK-48

I am very confused and see my Dr. again this week (RA) I really do not know what questions to ask or what test should be run next. Please can you help me - I just want the quality of my life to improve and spend enjoyable time with my son.

[Sylvia12]

I hope this helps someone- From what I've learned, it is NEVER normal to have elevated calcium in your blood if you have no other medical problems. When I was told my lab results were off, the first thing I did was search online. Boy, was I scared! Thank goodness someone out there posted a letter directing me to www.parathyroid.com on a forum such as this one. I am now trying to repay the favor. Pay forward, if you will. I am sure things would be different for me now if I hadn't run across that posting when I did. I am an operating room nurse and also a three week post op parathyroidectomy surgery patient. I live in Virginia and flew to Tampa, Florida for the surgery just last month. At first I was very skeptical. I thought the site was like a scam. But, after much research and MANY hours spent inquiring about this surgeon, I felt very comfortable. I was treated like royalty and met many other patients from all over the world. My only complaint was the 3 month wait due to the surgeon's schedule. That alone told me something! My surgery took 16 minutes, skin to skin. Local sedation for anesthesia. (no ET tube down your throat) I left the hospital about an hour and half after surgery and went out to lunch. Before you ask, no, I am not affiliated with the surgeon nor the hospital. My local doctor here in VA suggested a local ENT doctor- great surgeon and well thought of in my community. However, knowing it would take a few hours in surgery (if they could find the adenoma) an incision much larger than the 1" one I now can hardly see, and I would be put to sleep with a tube down my throat (this scared me the most- anesthesia) didn't give me a warm feeling. First, I think I should tell you that when looking back on my lab work (as far as 1999) my calcium levels were elevated. Nothing was every mentioned by my doctor. Before you say anything, yes, I am a nurse, but, no, I didn't think to question the elevation or even to keep an eye on it.  On a routine check in 2005, my serum levels were 11.8. Red flag for my doctor (Endocrinologist) He ordered a PTH test and that too, was elevated to 111. (norm is 12-65) I guess what I am trying to say is I lived with a parathyroid gland that grew to the size of a walnut for well over a decade, per the surgeon. A normal parathyroid gland is the size of a grain of rice or small pea. In the 3 short weeks since having the surgery, I have noticed a dramatic difference in my aches, pains, moods, energy and oh, so many other things. One of the first things I noticed the night of my surgery, is that I didn't have to run (I do mean run!) to the bathroom to empty my bladder as often. The next surgery on my list was going to be a pelvic floor/bladder lift. Not needed now, but who knew? Because I don't have that sense of urgency to use the bathroom, I now sleep sounder and longer, which has helped my moods even more. I am still a *****, as the surgery was supposed to help with my crankiness, but I guess some things are just innate! I don't know if I am allowed to post my email address here but I will try- ***@**** I hope this helps someone like the posting helped me last year.

[AliK]

Hi,
has anyone experienced a hyper parathyroid diagnois (hypercalcemia) but tests can not show the gland that is bad? I have now had, 2 PTH scans, an MRI, an ultrasound. I have to have surgery because at 42 yrs I'm already showing bone loss in my spine and hip. I don't have many symptons, but my doctor suggests not waiting any longer. I'm a bit nervous, letting the surgeon go into my neck without knowing what he's going after.
Anyone had a similar problem?

[untilyousee1]

I too have been diagnosed with hyper calcemia (10.6), with a low pth level. (18) Which rules out the most common cause parathyroidism.   With no insurance and no way of finding out whats causing this.. its hard to deal with.  If anyone has found out anything else with theirs please respond.  

Thanks.

[Jaylyn]

P.S. to prior post:  This may go without saying, but I should also mention that I do have elevated ANA (can't recall how high) and this is supposedly related to Hashimotos Thyroiditis.  I have had Graves Ophthalmology issues; however, I don't know if my Hashimotos is still in the Graves mode...probably not, as this was the case back in 1990 when I was diagnosed, and I was told it is common to be in the Graves mode for a time only and the thyroid meds were so that eventually I didn't become hypothyroid.  Mentioning this only in case is makes some difference to anyone out there with any knowlede on the pending questions.

[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 LABS REVEAL ANYTHING ELSE THAT WOULD POINT TO CANCER IF I HAD CANCER?  
Any additional information would sure be helpful!  Thanks very much.

[caravan25]

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

[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