Causes of Hypocalcemia and Hypercalcemia

Causes of Hypocalcemia

1.    Artifact (low serum albumin; rapid volume expansion)

2.    Hypoparathyroidism

3.    Pseudohypoparathyroidism

4.    Postoperative resection of parathyroid adenoma (transient)

5.    Hypomagnesemia

6.    Chronic renal failure (hyperphosphatemia)

7.    Postoperative thyroidectomy for Graves disease (transient)

8.    Metastatic carcinoma (especially prostate and breast)

9.    Acute pancreatitis

10.Malaborption (may or may not have diarrhea) (calcium; vitamin D; mangesium)

11.Chelation (EDTA; large transfusions of citrated blood)

12.Drugs

• Plicamycin
• Diphenylhydantion

13.Neonatal

• Meaternal hypercalcemia;
• Diabetes mellitus;
• Cow’s milk or
• High phosphate formula;
• Respiratory distress syndrome)

14.Hyperphosphatemia

• IV,
• Oral or enema phosphate;
• Chemotherapy of responsive tumors; (especially leukemias, lymphomas)

15.Vitamin D resistance syndromes 

Causes of Hypercalcaemia

1.    Artifact

• Laboratory error
• High serum protein concentration
• Dehydration
• Excess tourniquet time

2.    Primary hyperparathyroidism

• Sporadic cases
• Familial variants

3.    Familial hypocalciuric Hypercalcemia

4.    Hypercalcemia of malignancy

• Solid tumors
• Multiple myeloma
• Adult T-cell leukemia/lymphoma

5.    Medications

• Thiazides
• Lithium carbonate
• Vitamin preparations (vitamin A and D)
• Calcium and antacids (Milk-alkali syndrome)

6.    Immobilization (especially with Paget’s disease)

7.    Thyrotoxicosis

8.    Adrenal insufficiency

9.    Granulomatous disease

·         e.g. sarcoidosis or

·         Histoplasmosis)

10.Acute renal failure (especially diuretic phase)

11.Infancy

• Idiopathic (sensitivity to vitamin D)
• Maternal gestational hypocalcemia