Long-term follow-up of patients with elevated serum calcium concentrations in Swedish primary care

Abstract

ObjectiveTo follow up patients with elevated calcium concentrations after 10 years.DesignLongitudinal, using medical records, questionnaires, and clinical investigation.SettingPrimary care in Tibro, Sweden, 2008–2010.Subjects127 patents with elevated calcium concentrations and 254 patients with normal calcium concentrations from the local community, attending the health care centre.Main outcome measuresDiagnoses and mortality in patients with elevated calcium concentrations in 1995–2000, compared with patients with normal calcium concentrations and the background population.ResultsThe proportion of patients for whom no underlying cause was detected decreased from 55% at baseline to 12% at follow-up. Primary hyperparathyroidism was most common in women, 23% at baseline and 36% at follow-up, and the cancer prevalence increased from 5% to 12% in patients with elevated calcium concentration. Mortality tended to be higher in men with elevated calcium concentrations compared with men with normal calcium concentrations, and was significantly higher than in the background population (SMR 2.3, 95% CI 1.3–3.8). Cancer mortality was significantly increased in men (p = 0.039). Low calcium concentrations were also associated with higher mortality (p = 0.004), compared with patients with normal calcium concentrations.ConclusionThis study underscores the importance of investigating patients with increased calcium concentrations suggesting that most of these patients – 88% in our study – will turn out to have an underlying disease associated with hypercalcaemia during a 10-year follow-up period. Elevated calcium concentrations had a different disease pattern in men and women, with men showing increased cancer mortality in this study.

Requests of laboratory tests for the diagnosis and management of calcium-phosphate disorders in Spain

“…Second S-calcium testing does not usually yield false positive results with a proper sampling technique 21 . At least 88% of patients with hypercalcaemia will turn out to have an underlying disorder during a 10-year follow-up period, which makes necessary careful investigation of such subjects 22 . Asymptomatic PHPT is usually detected in health screenings.…”

Quality of life and health care consumption in primary care patients with elevated serum calcium concentrations in - a prospective, case control, study

“…However, the highest calcium values at baseline were found among those who died during the observation period, and almost half of the 46 patients with pHPT had undergone parathyroidectomy (and in most cases became normocalcaemic after surgery) [2]. This contributes to the decline of calcium concentrations at group level.…”

Italian Society of Endocrinology Consensus Statement: definition, evaluation and management of patients with mild primary hyperparathyroidism

“…Clinical presentation of PHPT has changed, being oligo-asymptomatic in up to 80 % of subjects when serum calcium is routinely determined [1,4]. Other causes of hypercalcemia are overtreatment with vitamin D medication, sarcoidosis, kidney disease, lithium and diuretic treatment, and skeletal diseases; a careful investigation of patients with increased calcium levels is therefore of utmost importance, since the majority of these patients will turn out to have an underlying disorder during a 10-year follow-up period [4]. Hypercalcemia should be confirmed in repeated measurements, including measurement of ionized calcium if available.…”