What it is
Healthy bones depend on a careful balance of calcium, phosphate, vitamin D and hormones, especially parathyroid hormone (PTH), made by four small glands in the neck.
Problems in this system include:
- High calcium (hypercalcaemia), most often caused by an overactive parathyroid gland (primary hyperparathyroidism)
- Low calcium (hypocalcaemia), for example after neck surgery or with low vitamin D or magnesium
- Parathyroid disease, where the glands make too much or too little hormone
- Metabolic bone disease, such as osteoporosis, and osteomalacia linked to vitamin D deficiency
These conditions are often found on routine blood tests before any symptoms appear.
Common symptoms
High calcium may cause:
- Tiredness, low mood or poor concentration
- Thirst and passing urine often
- Constipation or stomach pain
- Kidney stones
- Bone pain or thinning bones
Low calcium may cause:
- Tingling around the mouth or in the fingers and toes
- Muscle cramps or stiffness
- In severe cases, seizures or an abnormal heart rhythm, which need emergency care
When to see a specialist
- A blood test shows high or low calcium
- You have kidney stones, especially if they keep coming back
- You have thinning bones or fractures without a clear cause
- You have symptoms of low calcium after thyroid or parathyroid surgery
- A parathyroid hormone (PTH) test is abnormal
Treatment and management
- Confirming the cause with blood and urine tests, and scans of the parathyroid glands where needed
- Referral for parathyroid surgery for suitable patients with an overactive gland
- Calcium and vitamin D treatment for low levels, with careful monitoring
- Protecting bones and kidneys with regular tests and bone density scans
Don't start high-dose calcium or vitamin D on your own when your calcium level is abnormal.
How an endocrinologist helps
Calcium disorders need several test results to be interpreted together. Dr. Marium Zaman works out the underlying cause, explains the options, and arranges monitoring or referral when surgery may help.
