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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What does the following urine calcium levels indicate?

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Dr. Mirjeta Guni

Endocrinologist

Practicing since :2006

Answered : 2021 Questions

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Posted on Fri, 31 Mar 2017 in Thyroid Problem and Hormonal Problems
Question: Need consult from endocrinologist
doctor
Answered by Dr. Mirjeta Guni 44 minutes later
Brief Answer:
About hyperparathyroidism treatment:

Detailed Answer:
Hello and thank you for asking!
I have gone carefully through your concern.

The urine calcium creatinine clearance ratio is suggestive for primary hyperparathyroidism (Calcium Creatinine Clearance Ratio > 0.01 suggestive of Primary Hyperparathyroidism (PHPT)).
There are cases when there is an adenoma or hyperplasia of parathyroid glands, but sestamibi is negative.

Although parathyroidectomy remains the only curative approach to most primary hyperparathyroidism cases, medical treatment with cinacalcet has been proven to be a reasonable alternative for several patient subgroups. Cinacalcet almost always controls hypercalcemia and hypophosphatemia sufficiently.

PTH levels are lowered (in most of the cases not normalized) and cognitive parameters improve.
The improvement of PTH and calcium levels (as well as clinical symptoms) is seen within 3-4 months.

Regarding to osteoporosis, while an increase in bone mineral density DEXA scan scores was not demonstrated in cinacalcet trials, the same applies to more than half of patients after parathyroidectomy.

The normal ranges of calcium in urine for Females: 20-275 mg/24-hour specimen. So normally a normal person has calcium in urine.

Hope I have answered your queries.
Best wishes,
Dr.Mirjeta
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Mirjeta Guni 1 hour later
Thanks
Is there a normal value for a random ursine calcium level ?
doctor
Answered by Dr. Mirjeta Guni 14 minutes later
Brief Answer:
About calcium in urine;

Detailed Answer:
Welcome back!
Calcium in urine is always judged by 24 hour collected urine.
There are no data about the calcium level at a sample urine.
Regards,
Dr.Mirjeta
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Mirjeta Guni 21 hours later
I suffer from muscular weakness
Initially they thought to be myasthenia gravis
But multiple intense investigations for antibodies are negative
So the neurologist excluded it
And a non progressive pan myopathy( proximal and distal) was diagnosed
At this time incidentally my serum calcium and PTH were known to be high for the first time ever
Hence I assume the weakness could be related to hyperparathyroidism

I also have some uncomfortable missed beats in the heart with rare giddiness
Which seems to lessen with co q-10
And I was also under the impression that this is related to hypercalcemia
But my cardiologist vehemently denied this. And said no relation of missed beats and calcium

However as they say sometimes the patient is the best doctor ,
My missed beats disappeared with cinacalcet

My questions
1. Now: assuming my weakness is due to high calcium
When can i expect improvement with cinacalcet?
2. Do u believe the link between the missed beats and high calcium ?
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Follow up: Dr. Mirjeta Guni 4 minutes later
And now my calcium and PTH are reduced with cinacalcet

However
Now when they plan surgery how did they assess my disease
Will they ask me to stop cinacalcet?
doctor
Answered by Dr. Mirjeta Guni 53 minutes later
Brief Answer:
About high calcium level:

Detailed Answer:
Hi again,
I can understand your situation.
The PTH level in most of the cases remain high during the treatment with cinacalcet but calcium levels can get back to normal within 3 months. Once the calcium level is within the normal ranges, the symptoms are expected to improve.
Arrhythmia is a common side effect of hypercalcemia. The ECG would give better information regarding to the type of arrhythmia and suggest rather it is caused by high calcium or not, anyway, if it is improved with normalization of calcium levels, there is no need to verify it.
As I explained you before, usually the first line of treatment of primary hyperparathyroidism is surgical removal. When it is contraindicated or unsuccessful, than cinacalcet is suggested.
You will need to stop it before intervention.

Wish you good health.
Regards,
Dr.Mirjeta
Above answer was peer-reviewed by : Dr. Raju A.T
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