Clinical presentation and etiological profile of patients with hypercalcemia admitted at a tertiary care institute

Background: Hypercalcemia is a common metabolic abnormality of varying severity that can be adequately diagnosed and treated. Primary hyperparathyroidism and malignant neoplasms are responsible for >90% of all cases. Objectives: To study the clinical presentation and etiological profile of hypercalcemic patients at a tertiary care institute over a period of 29 months. The number of patients of hypercalcemia due to other rare cause like vitamin D intoxication have been increasing mainly due to over the counter supplementation. Methods: Thirty subjects 18(60%) females and 12(40%) males with a mean age of 65.5±10.28 with hypercalcemia were studied. The first step in evaluating hypercalcemia was confirming it first, an initial evaluation included the measurement of intact parathyroid hormone and 25-hydroxy vitamin D levels in patients with history of multiple injections of vitamin D. Results: Out of 30 patients studied, the most common clinical presentation was altered sensorium in 10(33.33%), incidental finding of hypercalcemia in 06(20%) and low back ache with bony pains in 04(13.3%) patients respectively. In etiological profile, the most common etiology was vitamin D intoxication in 11(36.67%) followed by malignancy in 09(30%) and hyperparathyroidism in 06(20%) patients respectively. Conclusion: In our study vitamin D intoxication (VDI) was the most common cause of hypercalcemia. Inadvertent excessive use of pharmaceutical preparations is the most common etiology of exogenous vitamin D toxicity.