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Dear Dr. Roach: A few years ago, at the age of 65, I was hospitalized and in critical condition with a calcium score of 14 mg/dL. After many tests, the diagnosis was hypercalcemia. After a 10-day hospital stay, I was discharged, and every test in the book was done to find the cause. All tests came back negative as to the cause, and still to this day, it isn't known what could have caused this. Any ideas? -- G.V.
Answer: "Hypercalcemia" just means a high calcium level, and there are many causes -- some of which are quite serious, including several cancers. A level of 14 mg/dL is very high. The many tests that they did makes a serious cause unlikely, and the fact that you're doing well years later confirms this.
The most common cause of high calcium is primary hyperparathyroidism, which should've been among the first tests they did. This is caused by a (usually) benign tumor in one of the parathyroid glands; there are usually four that sit on top of your thyroid gland (hence the name). Parathyroid hormone is the key regulator of calcium in the body.
I suspect that you had pseudohypercalcemia -- an apparent high calcium level that is actually normal. This is caused by abnormal protein binding of calcium, which, in turn, can be caused by abnormal protein levels in the blood. Some of these abnormal protein levels include high albumin (found with dehydration) and high immunoglobulin proteins (found with multiple myeloma). Again, since your tests are all normal now, a serious condition is very unlikely.
The classic cause of pseudohypercalcemia is leaving the tourniquet on too long when drawing blood. As the blood gets more acid from the muscles, calcium gets unbound from albumin, leading to an artifactually high number. This can be easily confirmed by measuring ionized calcium.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.