Kidney Stones, Elevated Serum Calcium . . . parathyroid?

[janeeth]

This question doesn't fit well in any of the listed forums, but I think this is my best shot.  I am a 34-year-old female with a 15 year history of calcium oxalate kidney stones.  I have passed at least 15, and according to a recent CT scan, I have at least 7 more (several in each kidney).  For several years I have been fatigued and have had sleep issues, which I attributed to having children who didn't sleep through the night.  I realized that sleep was an issue when they began sleeping through and I could not make it more than 4-5 hours.  Also have experienced increased heart palpitations over past 6 months which have led to anxiety.  I am taking Lexapro for the anxiety.  (Palps were evaluated and determined to be PVCs.)

I recently went through tests due to the presence of kidney stones.  Blood tests revealed mild elevation in serum calcium (10.3 with 10.2 being the upper limit).  All other urine and blood tests were within normal range.  I met with my urologist yesterday, who says calcium level is not THAT high, so we should just wait and check in 6 months.  I'm not certain how to proceed, because I don't feel well and haven't for quite a while.  But I don't want to waste my time or another physician's if the "wait and see" approach is the best one available.

I am very fatigued and have frequent headaches.  I am a runner and noticed last May that I wasn't able to run as far or as fast.  I really want to feel good again!  Am I wasting energy worrying about nothing, or would you suggest further evaluation given the elevated calcium and presence of kidney stones?  

Thanks so much for your opinion.

[Mark Lupo, M.D.]

your calcium is clearly elevated and would be probably higher if it weren't spilling into the urinary tract and causing stones.  This is most likely primary hyperparathyroidism - would check a PTH and ionized calcium along with another regular calcium level to confirm the diagnosis.  

Probably worth checking thyroid levels (at least a TSH) to screen for thyroid problems as cause of the palpitations.

Sometimes parathyroid problems are overlooked because docs don't see it frequently enough - with this history a slightly high calcium is a big red flag - unless your taking lots of supplemental calcium or a diuretic like HCTZ.

Will follow this post - give feedback regarding the PTH level.

[janeeth]

Dr. Lupo,
Many thanks for your response.  I do not care for dairy products, and I do not take any kind of supplement (never have taken vitamins), so my calcium intake generally comes from bread, cereals, etc.  The amount of calcium in my urine is within normal range although my blood calcium is elevated.  Is that possible with primary hyperparathyroidism?  

I will contact an endocrinologist and investigate this further.  I'll certainly let you know when the test results are complete.

Regards,
Melissa

[janeeth]

I do eat a serving of cheese and have a 1/4 cup of milk in my cereal each day, but that's the extent of my dairy consumption.  Thought it might be worth clarifying.

[Mark Lupo, M.D.]

This is most likely primary hyperpara -- with the stones it does not matter if the urine calcium is high -- in fact the urine calcium of patients with primary hyperpara is unpredictable - so not worth re-measuring if the PTH is high and the Calcium is high  (yes, even 10.3 with a normal up to 10.2).  Post the results and I will follow along.

[janeeth]

Dr. Lupo,
I just received some results from my most recent bloodwork.  My calcium level was 10.5 this time, and my PTH was 36.8.  My ionized calcium is not back yet.  My physician says this could be related to parathyroid, but it may be low level and something to watch.  What are your thoughts?

Thanks so much for your help.

Regards,
Melissa

[janeeth]

Dr. Lupo,
I should mention that the range for the lab is 8.5-10.2 for calcium and 15-65 for PTH.  

[tiffanielise]

A related discussion, Kidney stones-pituatary thyroid was started.