[Hypercalcemia in the elderly]

The symptoms which are caused by hypercalcemia are variable and unspecific. In the elderly the functional capacity of homeostatic mechanisms is less than in young people and at the same time the prevalence of diseases which may cause hypercalcemia is greater. One should be aware of the possibility of hypercalcemia in patients presenting vague gastrointestinal and/or psychiatric complaints or symptoms. The prevalence of hypercalcemia in elderly women may well be 3%. Hypercalcemia leads to renal loss of salt and disturbances of renal function. An increasing inability to excrete the calcium overload is the result. Only in primary hyperparathyroidism renal function remains generally normal and moderately increased calcium levels may exist for years without serious consequences. Important causes of hypercalcemia in the elderly are hyperthyroidism, malignant disease and abrupt immobilization with previously elevated skeletal remodelling activity. Thiazide diuretics may precipitate the hypercalcemic state. Diagnosis is relatively simple and is based on a limited package of laboratory tests. Treatment should always begin with the restoration of the extracellular fluid volume. This is followed by inhibition of bone resorption by means of bisphosphonates or corticosteroids and treatment of the underlying disease.