Hypercalcemia in children and adolescents.
OBJECTIVE
In this review, we define hypercalcemia levels, common causes for hypercalcemia in children, and treatment in order to aid the practicing pediatrician.


RESULTS
One rare cause of hypercalcemia in the child is familial hypocalciuric hypercalcemia (also termed familial benign hypercalcemia). Mutations that inactivate the Ca-sensing receptor gene FHH have been described as an autosomal dominant disorder, but recently milder mutations in the CASR have been shown to cause hypercalcemia when homozygous.


CONCLUSIONS
Normal serum levels of calcium are maintained through the interplay of parathyroid, renal, and skeletal factors. In this review, we have distinguished the neonate and infant from the older child and adolescent because the causes and clinical features of hypercalcemia can differ in these two age groups. However, the initial approach to the medical treatment of severe or symptomatic hypercalcemia is to increase the urinary excretion of calcium in both groups. In most cases, hypercalcemia is due to osteoclastic bone resorption, and agents that inhibit or destroy osteoclasts are, therefore, effective treatments. Parathyroid surgery, the conventional treatment for adults with symptomatic primary hyperparathyroidism, is recommended for all children with primary hyperparathyroidism.
Lietman
Steven A
SA
Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. lietmas@ccf.org
Germain-Lee
Emily L
EL
Levine
Michael A
MA
D000293:Adolescent; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002116:Calcitonin / Q000627:therapeutic use; D002118:Calcium / Q000097:blood / Q000652:urine; D020013:Calcium Signaling; D002648:Child; D020022:Genetic Predisposition to Disease; D006801:Humans; D006934:Hypercalcemia / Q000235:genetics / Q000378:metabolism / Q000628:therapy; D009154:Mutation; D016105:Parathyroidectomy; D011379:Prognosis; D044169:Receptors, Calcium-Sensing / Q000235:genetics
D050071:Bone Density Conservation Agents; C095550:CASR protein, human; D044169:Receptors, Calcium-Sensing; D002116:Calcitonin; D002118:Calcium