Skip to content
2000
  1. Home
  2. A-Z Publications
  3. Current Drug Safety
  4. Fast Track Articles
  5. Fast Track Article
image of A Biochemical Investigation of the Prevalence of Hypercalcemia and Thiazide-Related Hypercalcemia in Patients

Abstract

Introduction and Objective

Hypercalcemia allied with thiazide diuretics is a widely acknowledged clinical presentation. Hence, the purpose of this investigation was to ascertain the prevalence of hypercalcemia and hypercalcemia linked to thiazides and to evaluate serum phosphorous, 25-hydroxyvitamin D, and parathyroid hormone (PTH).

Methods

This prospective, cross-sectional research study involved all patients, including outpatients, and was conducted over a 12-month period. Between December 2017 and December 2018, an aggregate of 373 patients were enrolled. All patients with hypercalcemia (albumin-corrected serum calcium > 10.8 mg/dL) had their medical information put on a proforma, together with the results of any tests (such as parathyroid hormone (PTH), 25-hydroxyvitamin D, and serum phosphorus).

Results

Out of 373 subjects, 7 (2%) were hypercalcemic. The mean corrected calcium levels in the normo-calcemic group were 9.46 ± 0.60 mg/dL (95% CI, 9.4 – 9.5), and that in the hypercalcemic group were 11.68 ± 0.82 mg/dL (95% CI, 10.9 – 12.4). Of the seven cases of hypercalcemia, 2 patients (28.6%) had thiazide-associated hypercalcemia (TAH) along with primary hyperparathyroidism (PHPT). Of the remaining 5 hypercalcemia patients, two more had PHPT, and one (14.3%) had hypervitaminosis D, whereas no cause was mentioned in the remaining 2 patients. Among the 4 PHPT patients, corrected calcium was slightly higher in those with TAH those without TAH, though the difference was statistically insignificant (11.32 ± 0.43 11.14 ± 0.39 mg/dL; P > 0.7).

Conclusion

TAH is the second primary cause of asymptomatic hypercalcemia after PHPT. Thus, close coordination between the clinicians, pharmacology, pharmacovigilance, and the biochemistry department may help in identifying these cases.

© 2025 Bentham Science Publishers
Loading

Article metrics loading...

/content/journals/cds/10.2174/0115748863317871241015060209
2025-02-25
2025-06-22

  • From This Site

    /content/journals/cds/10.2174/0115748863317871241015060209
    dcterms_title,dcterms_subject,pub_keyword
    -contentType:Contributor -contentType:Concept -contentType:Institution
    10
    5
Loading full text...

Full text loading...

References

  1. Weir M.R. Hypertension. Ann. Intern. Med. 2014 161 11 ITC1 ITC15 10.7326/0003‑4819‑161‑11‑201412020‑01006 25437425
    [Google Scholar]
  2. Aitken M. Kleinrock M. Lyle J. Caskey L. Medicine use and shifting costs of healthcare: A review of the use of medicines in the United States in 2013. IMS Institute Healthc. Inform. 2014
    [Google Scholar]
  3. Grieff M. Bushinsky D.A. Diuretics and disorders of calcium homeostasis. Semin. Nephrol. 2011 31 6 535 541 10.1016/j.semnephrol.2011.09.008 22099510
    [Google Scholar]
  4. Rejnmark L. Vestergaard P. Heickendorff L. Andreasen F. Mosekilde L. Loop diuretics alter the diurnal rhythm of endogenous parathyroid hormone secretion. A randomized‐controlled study on the effects of loop‐ and thiazide‐diuretics on the diurnal rhythms of calcitropic hormones and biochemical bone markers in postmenopausal women. Eur. J. Clin. Invest. 2001 31 9 764 772 10.1046/j.1365‑2362.2001.00883.x 11589718
    [Google Scholar]
  5. Christensson T. Hellström K. Wengle B. Hypercalcemia and primary hyperparathyroidism. Prevalence in patients receiving thiazides as detected in a health screen. Arch. Intern. Med. 1977 137 9 1138 1142 10.1001/archinte.1977.03630210024009 901082
    [Google Scholar]
  6. Heedman P.A. Stenström G. Clinical findings in patients with hypercalcaemia. A preliminary investigation based on biochemical screening. Acta Med. Scand. 1973 193 1-6 167 173 10.1111/j.0954‑6820.1973.tb10557.x 4693780
    [Google Scholar]
  7. Wermers R.A. Kearns A.E. Jenkins G.D. Melton L.J. III Incidence and clinical spectrum of thiazide-associated hypercalcemia. Am. J. Med. 2007 120 10 911.e9 911.e15 10.1016/j.amjmed.2006.07.044 17904464
    [Google Scholar]
  8. Griebeler M.L. Kearns A.E. Ryu E. Thapa P. Hathcock M.A. Melton L.J. III Wermers R.A. Thiazide-associated hypercalcemia: Incidence and association with primary hyperparathyroidism over two decades. J. Clin. Endocrinol. Metab. 2016 101 3 1166 1173 10.1210/jc.2015‑3964 26751196
    [Google Scholar]
  9. Wilson J.M.G. Current trends and problems in health screening. J. Clin. Pathol. 1973 26 8 555 563 10.1136/jcp.26.8.555 4593600
    [Google Scholar]
  10. Whitehead T.P. Wootton I.D.P. Biochemical profiles for hospital patients. Lancet 1974 304 7894 1439 1443 10.1016/S0140‑6736(74)90088‑9 4140344
    [Google Scholar]
  11. Mays E.T. Weakley S.D. Serum multichannel autoanalyzers in the detection of hypercalcemia and hyperparathyroidism. Surg. Gynecol. Obstet. 1971 133 4 603 608 5096308
    [Google Scholar]
  12. Boonstra C.E. Jackson C.E. Serum calcium survey for hyperparathyroidism: Results in 50,000 clinic patients. Am. J. Clin. Pathol. 1971 55 5 523 526 10.1093/ajcp/55.5.523 5090209
    [Google Scholar]
  13. McLellan G. Baird C.W. Melick R. Hypercalcaemia in an Australian hospital adult population. Med. J. Aust. 1968 2 8 354 356 10.5694/j.1326‑5377.1968.tb82823.x 5686431
    [Google Scholar]
  14. Harrop J.S. Bailey J.E. Woodhead J.S. Incidence of hypercalcaemia and primary hyperparathyroidism in relation to the biochemical profile. J. Clin. Pathol. 1982 35 4 395 400 10.1136/jcp.35.4.395 7076867
    [Google Scholar]
  15. Christensson T. Hellström K. Wengle B. Alveryd A. Wikland B. Prevalence of hypercalcaemia in a health screening in Stockholm. Acta Med. Scand. 1976 200 1-6 131 137 10.1111/j.0954‑6820.1976.tb08208.x 961467
    [Google Scholar]
  16. Austin P.C. Mamdani M.M. Tu K. Zwarenstein M. Changes in prescribing patterns following publication of the ALLHAT trial. JAMA 2004 291 1 44-a 45 10.1001/jama.291.1.44‑b 14709573
    [Google Scholar]
  17. Stenström G. Heedman P.A. Clinical findings in patients with hypercalcaemia. A final investigation based on biochemical screening. Acta Med. Scand. 1974 195 1-6 473 477 10.1111/j.0954‑6820.1974.tb08174.x 4835155
    [Google Scholar]
  18. Brickman A.S. Massry S.G. Coburn J.W. changes in serum and urinary calcium during treatment with hydrochlorothiazide: Studies on mechanisms. J. Clin. Invest. 1972 51 4 945 954 10.1172/JCI106889 4552338
    [Google Scholar]
  19. Riis B. Christiansen C. Actions of thiazide on vitamin D metabolism: A controlled therapeutic trial in normal women early in the postmenopause. Metabolism 1985 34 5 421 424 10.1016/0026‑0495(85)90206‑9 3887100
    [Google Scholar]
  20. Bazzini C. Vezzoli V. Sironi C. Dossena S. Ravasio A. De Biasi S. Garavaglia M. Rodighiero S. Meyer G. Fascio U. Fürst J. Ritter M. Bottà G. Paulmichl M. Thiazide-sensitive NaCl-cotransporter in the intestine: Possible role of hydrochlorothiazide in the intestinal Ca2+ uptake. J. Biol. Chem. 2005 280 20 19902 19910 10.1074/jbc.M411961200 15781471
    [Google Scholar]
  21. Heath H. III Postural and venous stasis-induced changes in total calcium. Mayo Clin. Proc. 2005 80 8 1101 10.4065/80.8.1101 16092594
    [Google Scholar]
  22. Bilezikian J.P. Potts J.T. Jr Fuleihan Gel-H. Kleerekoper M. Neer R. Peacock M. Rastad J. Silverberg S.J. Udelsman R. Wells S.A. Jr Summary statement from a workshop on asymptomatic primary hyperparathyroidism: A perspective for the 21st century. J. Bone Miner. Res. 2002 17 N2 N11 12412771
    [Google Scholar]
  23. Farquhar C.W. Spathis G.S. Barron J.L. Levin G.E. Failure of thiazide diuretics to increase plasma calcium in mild primary hyperparathyroidism. Postgrad. Med. J. 1990 66 779 714 716 10.1136/pgmj.66.779.714 2235800
    [Google Scholar]
/content/journals/cds/10.2174/0115748863317871241015060209
Loading
A Biochemical Investigation of the Prevalence of Hypercalcemia and Thiazide-Related Hypercalcemia in Patients
Bentham Science Publishers ; https://doi.org/10.2174/0115748863317871241015060209
/content/journals/cds/10.2174/0115748863317871241015060209
/content/journals/cds/10.2174/0115748863317871241015060209
Loading

Data & Media loading...

Supplements

Supplementary material is available on the publisher's website along with the published article.

file format download Download

  • Article Type:     Research Article
Keywords: Hypercalcemia ; 25-hydroxyvitamin D ; phosphorous ; thiazide-associated hypercalcemia ; primary hyperparathyroidism ; parathyroid hormone

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test