You're back with the podcast meant for the type of medical folks that the more they learn,

the more they want to know. As important and interesting as knowledge is about hypercalcemia,

it is the experience of the patient that matters most. And very often when we first start learning

about symptoms with hypercalcemia, we learn the

pneumonic stones, bones, abdominal moans, and psychic groans, which is frequently learned

in medical school, but in reality, many patients are asymptomatic because most have mild

hypercalcemia. The higher the calcium level goes,

the more likely you are to experience symptoms. And very few people will remain symptom-free

by the time the serum calcium level reaches 14. Let's start talking about gastrointestinal symptoms. Subjectively, the most common symptom

I have noticed patients telling me about is constipation. It can be really severe, like the type

when they say it's been 10 days since they had a bowel movement, that kind of severe. And while not totally understood,

hypercalcemia is thought to decrease smooth muscle tone. Now, sticking with GI symptoms,

when we admit patients for acute pancreatitis, we routinely look at the labs to rule out

hypercalcemia because calcium can

get deposited in a pancreatic duct and the elevated calcium may also activate trypsinogen.

However, the more common GI symptoms of anorexia, nausea, and vomiting are more typical symptoms of hypercalcemia.

Peptic ulcer disease can also occur, but the incidence is probably only minimally elevated

compared to the rest of the population, with the exception of those who have primary

hyperparathyroidism associated with MEN1.

Those multiple endocrine neoplasia 1 patients can have gastronomas causing Zollinger-Ellison

syndrome.

Zollinger-Ellison is a condition caused by neuroendocrine tumors that secrete excess amounts of gastrin,

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