The way in which the body processes calcium and phosphate, the function of vitamin D (which acts more like a hormone than a vitamin), and the formation of bone are all tied together into a system that involves 2 other hormones—parathyroid hormone and calcitonin—that are secreted by the parathyroid and thyroid glands.
Disorders of calcium and phosphorus metabolism that affect the skeletal system are discussed in the topic on bone, joint, and muscle disorders.
Calcium-regulating Hormones
Calcium is an essential component of the skeleton, and it has important functions in muscle contraction, blood clotting, enzyme activity, the nervous system, and hormone release, among others. Precise control of calcium in the body is vital to health. Parathyroid hormone, vitamin D, and calcitonin all interact to keep the level of calcium steady, despite variations in intake and excretion. Other hormones may also contribute to maintaining the balance of calcium in the body.
Parathyroid hormone is created and stored in the parathyroid glands, which are located on either side of the thyroid gland in the neck. The creation of this hormone is regulated by a feedback mechanism that involves the level of blood calcium. The primary function of parathyroid hormone is to control the level of calcium by affecting the movement of calcium into and out of bone, the retention of calcium by the kidneys, and absorption of calcium from the digestive tract.
Vitamin D is the second major hormone involved in the regulation of calcium metabolism. In several species, including horses and people, vitamin D is formed in the skin after exposure to ultraviolet light (such as sunshine). In contrast, cats are not able to form enough vitamin D in the skin and depend on dietary intake. Parathyroid hormone and conditions that stimulate its secretion, as well as reduced phosphate levels, increase the formation of vitamin D. Conversely, high levels of phosphorus in the blood reduce vitamin D activation. Under certain conditions, such as pregnancy and growth, other hormones can stimulate the formation of active vitamin D.
Calcitonin is a hormone secreted by certain cells of the thyroid gland in mammals. When the level of blood calcium increases, calcitonin is released to prevent hypercalcemia (abnormally high levels of calcium).
Hypocalcemia
Hypocalcemia is an abnormally low level of calcium in the blood, leading to twitching, muscle tremors, and seizures. The causes of hypocalcemia include previous surgical removal of the parathyroid glands (leading to hypoparathyroidism), kidney disease or failure, and calcium imbalance in nursing females.
Hypoparathyroidism is characterized by low calcium levels, high phosphate levels, and either temporary or permanent insufficiency of parathyroid hormone. It is rare in cats, but can be caused by previous removal of the parathyroid glands as a treatment for hyperthyroidism or for a parathyroid tumor. Common signs of hypocalcemia include muscle tremors and twitches, muscle contraction, and generalized convulsions. Diagnosis is based on history, signs, low calcium and high phosphorus levels, and the serum parathyroid hormone level. Other causes of hypocalcemia must be eliminated.
The goal of treatment is to return the level of blood calcium to normal and to eliminate the underlying cause. If a cat is having muscle spasms or seizures because of low calcium levels, immediate treatment with intravenous calcium is needed. Dietary supplements of calcium, often along with vitamin D, are prescribed for longterm treatment.
Chronic kidney failure is probably the most common cause of hypocalcemia. However, the hypocalcemia that occurs with kidney failure does not tend to cause signs or lead to the nervous system signs that are seen in hypoparathyroidism. Treatment usually involves dietary restriction and treatment to lower phosphate concentration in the blood.
Administration of over-the-counter enemas made for people (for example Fleet® enemas) can cause severe electrolyte (salt) and fluid abnormalities in cats. Exposed cats can develop twitching, muscle tremors, and shock. The effects are life-threatening and require immediate emergency treatment. Never give your cat medications made for humans without first consulting your veterinarian.
Several other diseases can also cause hypocalcemia, including low levels of protein in the blood, decreased absorption from food, eclampsia (due to lactation), pancreatitis (inflammation of the pancreas), and ingestion of calcium-binding agents (such as antifreeze) (see table below).
Causes and Treatment of Low Blood Calcium Levels (Hypocalcemia)
Cause | Reason | Treatment |
|---|---|---|
Hypoparathyroidism | Deficiency of parathyroid hormone leads to low blood calcium levels | See page content |
Chronic kidney failure | Damaged kidney does not effectively regulate calcium levels | Most cases are mild; if needed, lower blood phosphate concentration through diet and medication |
Eclampsia (puerperal tetany) | Occurs in lactating females; may be due to imbalance between intake and outflow of calcium | Intravenous calcium; weaning of litter if possible |
Chelating agents (for example, ethylene glycol in antifreeze) | Chelating agent binds to calcium | Depends on the chelating agent involved |
Hypercalcemia
Hypercalcemia is an abnormally high level of calcium in the blood. Excessive calcium in the blood is harmful to all tissues but especially the kidneys, nervous system, heart, and blood vessels. Extremely high calcium levels can be life threatening. The signs associated with this condition depend on how high the calcium level is, how quickly it develops, and how long it lasts. The most common signs are increased thirst and urination, followed by reduced appetite, vomiting, constipation, weakness, depression, muscle twitching, and seizures.
Causes and Treatment of Hypercalcemia (Increased Blood Calcium Levels) in Cats
Cause | Mechanism | Treatment |
|---|---|---|
Primary hyperparathyroidism (relatively rare in cats) | Parathyroid glands are overactive (often due to a tumor) and secrete excessive parathyroid hormone | Removal or destruction of tumor |
Hypercalcemia caused by cancer (malignant hypercalcemia); most commonly caused by lymphoma, squamous cell carcinoma, and multiple myeloma | Increased bone breakdown and resorption triggered by cancer cells causes higher levels of calcium in blood | Depends on specific type of cancer; the presence of hypercalcemia is often associated with a poorer outlook and a shorter survival time |
Chronic kidney failure | Exact mechanism is unknown; most common cause of hyper-calcemia in cats | Supportive care |
Hyperthyroidism (increased production of thyroid hormones) | Most cases are caused by a benign tumor of the thyroid gland that produces excess thyroid hormones. Those hormones can cause calcium levels to increase. | Surgery or radiation are often used to treat the tumor. Once that's been done, calcium levels may return to normal, but should be monitored. |
Granulomatous disease (masses of white blood cells that can form because of certain fungal, bacterial, and parasitic infections) | Inflammation activates the type of white blood cells that can increase levels of active vitamin D | Treatment of underlying disease, for example, antifungal drugs or surgery |
Idiopathic hypercalcemia of cats | Unknown cause; affects cats 2 to 13 years old (either sex) | Diet change and possibly medication (prednisone or bisphosphonates) |
In cats, kidney failure, tumors, and a syndrome called idiopathic hypercalcemia are the most common causes of high blood calcium levels (also see table above). Hyperthyroidism is a common condition of cats that rarely causes hypercalcemia.
Hypercalcemia is treated by identifying and treating the condition causing it. However, the cause may not always be apparent and may require a number of tests, including routine and specialized blood tests, diagnostic imaging (such as x-rays and ultrasonography), and biopsies. Supportive treatment, including fluids, diuretics (“water pills”), and glucocorticoids, is often needed to lower the level of calcium in the blood. Additional drugs are also available. Specific treatments are listed in the table Causes and Treatment of (Hypercalcemia above.
For More Information
Also see professional content regarding the parathyroid glands and disorders of calcium metabolism.
