Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-5c6d5d7d68-pkt8n Total loading time: 0 Render date: 2024-08-07T09:34:00.306Z Has data issue: false hasContentIssue false

Chapter 32 - Disorders of calcium metabolism

from Section 9 - Endocrinology

Published online by Cambridge University Press:  05 September 2013

By
Pamela T. Prescott
Edited by
Michael F. Lubin ,
Thomas F. Dodson  and
Neil H. Winawer
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Neil H. Winawer
Affiliation:
Emory University, Atlanta
Get access

Summary

Calcium is an abundant mineral and has diffuse cellular functions in bone metabolism, cell division, coagulation, enzyme regulation, glycogen metabolism, muscle contraction, neurotransmission, protein synthesis, and degradation. Calcium is ingested in the diet and absorbed in the small intestine. It is distributed throughout the body, but 99% appears in the bone [1–3]. Adult humans contain more than 1 kg of calcium, of which over 99% is skeletal and dental and only 0.1% is in extracellular fluids. About half the calcium in serum is bound to protein, primarily of which is albumin. Decreases in serum albumin are accompanied by decreases in calcium (a drop of 1 g/dL of albumin lowers the calcium by about 0.8 mg/dL). Several calcium determinations and measurement of ionized (physiologically active) calcium levels may be needed to accurately assess calcium status..

Calcium is maintained in a very narrow range by a redundant system of parathyroid hormone (PTH), vitamin D, and calcitonin; all acting at multiple target organs, including bone, kidneys, and the gastrointestinal tract. As ionized (free, metabolically active) calcium levels decrease, the parathyroid glands secrete PTH, which raises calcium levels by stimulating bone resorption, renal calcium reabsorption, phosphate excretion, and renal 1,25-dihydroxycholecalciferol (1,25-[OH]2D3) synthesis. Vitamin D, in turn, promotes bone resorption, increases intestinal absorption of dietary calcium and phosphate, and inhibits PTH secretion [1,4–14]. Finally, calcitonin, released by parafollicular cells of the thyroid in response to hypercalcemia, has been shown to transiently inhibit bone resorption [5].

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 366 - 372
Publisher: Cambridge University Press
Print publication year: 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bringhurst, F.Demay, M, Kroenberg, H.Hormones and disorders of mineral metabolism. In Wilson, JD, Kronenberg, KM, Melmed, S, Polansky, KS, Laresen, PR, eds. Williams Textbook of Endocrinology. 11th edition. Philadelphia, PA: W. B. Saunders/Elsevier Health Sciences; 2007, pp. 1155–209.Google Scholar
O'Toole, JF.Disorders of calcium metabolism. Nephron Physiol 2011; 118: 22–27.CrossRefGoogle ScholarPubMed
Perez, AV, Picotto, G, Carpentieri, AR et al. Minireview on regulation of intestinal calcium absorption. Emphasis on molecular mechanisms of transcellular pathway. Digestion 2008; 77: 22–34.CrossRefGoogle ScholarPubMed
Marx, SJ.Hyperparathyroid and hypoparathyroid disorders. N Engl J Med 2000; 343: 1863–75.CrossRefGoogle ScholarPubMed
Marcus, R.Diagnosis and treatment of hyperparathyroidism. Rev Endocr Metab Disord 2000; 1: 247–52.CrossRefGoogle ScholarPubMed
Holick, MF.Vitamin D deficiency. N Engl J Med 2007; 357: 266–81.CrossRefGoogle ScholarPubMed
Baird, GS.Ionized calcium. Clin Chim Acta 2011; 412: 696–701.CrossRefGoogle ScholarPubMed
DeLuca, HF.Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr 2004; 80 (Suppl): 1689S–96S.CrossRefGoogle ScholarPubMed
Wallach, S, Rousseau, G, Martin, L, Azria, M.Effects of calcitonin on animal and in vitro models of skeletal metabolism. Bone 1999; 25: 509–16.CrossRefGoogle ScholarPubMed
Khan, MI, Waguespack, SG, Hu, MI.Medical management of postsurgical hypoparathyroidism. Endocr Pract 2011; 17 (Suppl 1): 18–25. Erratum in 2011; 17: 967. Dosage error in article text.CrossRefGoogle ScholarPubMed
Prince, MR, Erel, HE, Lent, RW et al. Gadodiamide administration causes spurious hypocalcemia. Radiology 2003; 227: 639–46.CrossRefGoogle ScholarPubMed
Gandhi, MJ, Narra, VR, Brown, JJ et al. Clinical and economic impact of falsely decreased calcium values caused by gadoversetamide interference. Am J Roentgenol 2008; 190: W213–17.CrossRefGoogle ScholarPubMed
Christakos, S, Ajibade, DV, Dhawan, P, Fechner, AJ, Mady, LJ.Vitamin D: metabolism. Endocrinol Metab Clin North Am 2010; 39: 243–53.CrossRefGoogle ScholarPubMed
Takeyama, K, Kato, S.The vitamin D3 1 alpha-hydroxylase gene and its regulation by active vitamin D3. Biosci Biotechnol Biochem. 2011; 75: 208–13.CrossRefGoogle ScholarPubMed
Holick, MF.Vitamin D: a D-Lightful health perspective. Nutr Rev 2008; 66 (10 Suppl 2): S182–94.CrossRefGoogle ScholarPubMed
Hollis, BW.Assessment and interpretation of circulating 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D in the clinical environment. Endocrinol Metab Clin North Am 2010; 39: 271–86.CrossRefGoogle ScholarPubMed
Hollis, BW, Wagner, CL.Normal serum vitamin D levels. N Engl J Med 2005; 352: 515–16.Google ScholarPubMed
Davis, CD.Vitamin D and cancer: current dilemmas and future research needs. Am J Clin Nutr 2008; 88: 565S–9S.CrossRefGoogle ScholarPubMed
Agarwal, M, Phan, A, Willix, R, Barber, M, Schwarz, ER.Is vitamin D deficiency associated with heart failure? A review of current evidence. J Cardiovasc Pharmacol Ther 2011; 16: 354–63.CrossRefGoogle ScholarPubMed
Pilz, S, März, W, Wellnitz, B et al. Association of vitamin D deficiency with heart failure and sudden cardiac death in a large cross-sectional study of patients referred for coronary angiography. J Clin Endocrinol Metab 2008; 93: 3927–35.CrossRefGoogle Scholar
Caramaschi, P, Dalla Gassa, A, Ruzzenente, O et al. Vitamin D and autoimmune rheumatic diseases. Clin Rheumatol. 2011; 30: 443–4.CrossRefGoogle ScholarPubMed
Bartley, J.Vitamin D: emerging roles in infection and immunity. Expert Rev Anti Infect Ther 2010; 8: 1359–69.CrossRefGoogle ScholarPubMed
Mora, JR, Makoto Iwata, M, Andrian, UH.Vitamin effects on the immune system: vitamins A and D take centre stage. Nature Reviews Immunology 2008; 8: 685–98.CrossRefGoogle Scholar
Hollis, BW.Assessment and interpretation of circulating 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D in the clinical environment. Endocrinol Metab Clin North Am 2010; 39: 271–86.CrossRefGoogle ScholarPubMed
Jones, G.Pharmacokinetics of vitamin D toxicity. Am J Clin Nutr 2008; 88: 582S–6S.CrossRefGoogle ScholarPubMed
Potts, JT.Parathyroid hormone: Past and present. J Endocrinol 2005; 187: 311–25.CrossRefGoogle ScholarPubMed
Aloia, JF, Feuerman, M, James, MS, Yeh, K.Reference range for serum parathyroid hormone. Endocr Pract 2006; 12: 137–44.CrossRefGoogle ScholarPubMed
Sokoll, LJ.Measurement of parathyroid hormone and application of parathyroid hormone in intraoperative monitoring. Clin Lab Med 2004; 24: 199–216.CrossRefGoogle ScholarPubMed
Barczynski, M, Konturek, A, Hubalewska-Dydejczyk, A, Cichon, S, Nowak, W.Evaluation of Halle, Miami, Rome, and Vienna intraoperative iPTH assay criteria in guiding minimally invasive parathyroidectomy. Langenbecks Arch Surg 2009; 394: 843–9.CrossRefGoogle ScholarPubMed
Lupoli, GA, Fonderico, F, Panico, A et al. Stricter criteria increase the validity of a quick intraoperative parathyroid hormone assay in primary hyperparathyroidism. Med Sci Monit 2009; 15: CR111–16.Google ScholarPubMed
Richards, ML, Thompson, GB, Farley, DR, Grant, CS.An optimal algorithm for intraoperative parathyroid hormone monitoring. Arch Surg 2011; 146: 280–5.CrossRefGoogle ScholarPubMed
Sugino, K, Ito, K, Nagahama, M et al. Minimally invasive surgery for primary hyperparathyroidism with or without intraoperative parathyroid hormone monitoring. Endocr J 2010; 57: 953–8.CrossRefGoogle ScholarPubMed
Liamis, G, Milionis, HJ, Elisaf, M.A review of drug-induced hypocalcemia. J Bone Miner Metab 2009; 27: 635–42.CrossRefGoogle ScholarPubMed
Ruppe, MD.Medications that affect calcium. Endocr Pract 2011; 17 (Suppl 1): 26–30.CrossRefGoogle ScholarPubMed
Iannuzzi, MC, Fontana, JRSarcoidosis: clinical presentation, immunopathogenesis, and therapeutics. J Am Med Assoc 2011; 305: 391–9.CrossRefGoogle ScholarPubMed
Broome, JT, Solorzano, CC.Lithium use and primary hyperparathyroidism. Endocr Pract 2011; 17 (Suppl 1): 31–5.CrossRefGoogle ScholarPubMed
Sharretts, JM, Kebebew, E, Simonds, WF.Parathyroid cancer. Semin Oncol 2010; 37: 580–90.CrossRefGoogle ScholarPubMed
Lameire, N, Van Biesen, W, Vanholder, R.Electrolyte disturbances and acute kidney injury in patients with cancer. Semin Nephrol 2010; 30: 534–47.CrossRefGoogle ScholarPubMed
Pelosof, LC, Gerber, DE.Paraneoplastic syndromes: an approach to diagnosis and treatment. Mayo Clin Proc 2010; 85: 838–54.CrossRefGoogle ScholarPubMed
De Sanctis, V, Fiscina, B, Ciccone, S.Severe hypercalcemia in a patient treated for hypoparathyroidism with calcitriol. Pediatr Endocrinol Rev 2010; 7: 363–5.Google Scholar
Bilezikian, JP, Khan, AA, Potts, JT; Third International Workshop on the Management of Asymptomatic Primary Hyperthyroidism. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. J Clin Endocrinol Metab 2009; 94: 335–9.CrossRefGoogle ScholarPubMed
Dunne, FP, Lee, S, Ratcliffe, WA et al. Parathyroid hormone-related protein (PTHrP) gene expression in solid tumours associated with normocalcaemia and hypercalcaemia. J Pathol 1993; 171: 215–21.CrossRefGoogle ScholarPubMed
Isowa, S, Shimo, T, Ibaragi, S et al. PTHrP regulates angiogenesis and bone resorption via VEGF expression. Anticancer Res 2010; 30: 2755–67.Google ScholarPubMed
Lumachi, F, Brunello, A, Roma, A, Basso, U.Cancer-induced hypercalcemia. Anticancer Res 2009; 29: 1551–5.Google ScholarPubMed
Stewart, AF.Clinical practice. Hypercalcemia associated with cancer. N Engl J Med 2005; 352: 373–9.CrossRefGoogle ScholarPubMed
Iannuzzi, MC, Fontana, JR.Sarcoidosis: clinical presentation, immunopathogenesis, and therapeutics. J Am Med Assoc 2011; 305: 391–9.CrossRefGoogle ScholarPubMed
Sharma, OP.Hypercalcemia in granulomatous disorders: a clinical review. Curr Opin Pulm Med 2000; 6: 442–7.CrossRefGoogle ScholarPubMed
Iqbal, AA, Burgess, EH, Gallina, DL, Nanes, MS, Cook, CB.Hypercalcemia in hyperthyroidism: patterns of serum calcium, parathyroid hormone, and 1,25-dihydroxyvitamin D3 levels during management of thyrotoxicosis. Endocr Pract 2003; 9: 517–21.CrossRefGoogle ScholarPubMed
Lameire, N, Van Biesen, W, Vanholder, R.Electrolyte disturbances and acute kidney injury in patients with cancer. Semin Nephrol 2010; 30: 534–47.CrossRefGoogle ScholarPubMed
McMahan, J, Linneman, T.A case of resistant hypercalcemia of malignancy with a proposed treatment algorithm. Ann Pharmacother 2009; 43(9): 1532–8.CrossRefGoogle ScholarPubMed
Major, P, Lortholary, A, Han, J et al. Zoledronic acid is superior to pamidronate in the treatment of hypercalcemia of malignancy: a pooled analysis of two randomized, controlled clinical trials. J Clin Oncol 2001; 19: 558–67.CrossRefGoogle ScholarPubMed
Deftos, LJ.Calcitonin as a drug. Ann Intern Med 1981; 95(2): 192–7.CrossRefGoogle ScholarPubMed
Silverberg, SJ, Rubin, MR, Faiman, C et al. Cinacalcet hydrochloride reduces the serum calcium concentration in inoperable parathyroid carcinoma. J Clin Endocrinol Metab 2007; 92(10): 3803–8.CrossRefGoogle ScholarPubMed
Aguilera, IM, Vaughan, RX.Calcium and the anaesthetist. Anaesthesia 2000; 55: 770–90.CrossRefGoogle ScholarPubMed
Cooper, MS, Gittoes, NJ.Diagnosis and management of hypocalcaemia. Br Med J 2008; 336: 1298–302.CrossRefGoogle ScholarPubMed
Urbano, FL.Signs of hypocalcemia: Chvostek's and Trousseau's. Hosp Physician 2000; 36: 43–5.Google Scholar
Mavroudis, K, Aloumanis, K, Stamatis, P et al. Irreversible end-stage heart failure in a young patient due to severe chronic hypocalcemia associated with primary hypoparathyroidism and celiac disease. Clin Cardiol 2010; 33(2): E72–5.CrossRefGoogle Scholar
Swaminathan, R.Magnesium metabolism and its disorders. Clin Biochem Rev 2003; 24(2): 47–66.Google ScholarPubMed
Aguilera, IM, Vaughan, RX.Calcium and the anaesthetist. Anaesthesia 2000; 55: 770–790.CrossRefGoogle ScholarPubMed
Vasa, FR.Endocrine problems in the chronically critically ill patient. Clin. Chest Med. 2001; 22: 193–208.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×