↑ [Ca++]

↑ or N PTH
↓ PTH

1⁰ HyperPTH

2⁰ HyperPTH
Drug Induced

1. Solitary Adenoma- 81% 3⁰ HyperPTH

Lithium
↓PO4 Related to ↑PTHr 2. Hyperplasia-15%
Protien (Lung Ca, RCC, 3. Carcinoma- 4% Familial Hypocalciuric
Pheochromocytoma) 4. MEN I & II Hypercalcemia

↑ or N PO4

Low Vit D metabolites ↑ Calcidiol or Vit D

activity

 Immobilization
 Milk alkalli syndrome (Hypercalcemia
with alkalosis and renal failure)
Granulomatous disease i.e. TB. sarcoid,
 Drugs: thiazide diuretics, CaC03, Hypervitaminosis D:
lymphoma (esp Hodgkins) which causes extra
theophylline, estrogen/tamoxifen excessive intake of vit
renal production of calcitriol by macrophages in
 Metastatic bone disease i.e. breast Ca D or its metabolites
the lung and lymph nodes Excessive calcitriol
which is mediated by Osteoclast intake
 Activating Factor (OAF) and various
cytokines
 High bone turnover i.e. hypervitaminosis
A, thyrotoxicosis, Paget's Disease