Should calcium be adjusted for albumin?

Question from a Parathyroid Peep Follower: 

I am entering my calcium values into the Calcium Pro App. Should I include albumin corrected calcium values? 

Here is the response we received from Dr. Jim Norman, founder of the Norman Parathyroid Center and the Calcium Pro App:

No, do not include albumin-corrected calcium levels.

This correction is ONLY used when people have severe protein malnutrition (typically about to die from a bad cancer and have lost a lot of weight, or have been hospitalized for weeks (not days) with bad health problems such as acute pancreatitis).

The correction should only be used to INCREASE the calcium (in patients with low serum protein and low serum albumin–which is a major blood protein). A low albumin will falsely lower the calcium, so doing a correction will increase the “actual” level of calcium. The opposite is NOT true. A high albumin should never be used to lower the measured serum calcium.

Thus, this “calculated” number should only be used on people who have chronic illness and are hospitalized and very sick. It will serve to INCREASE the serum calcium level (whatever the number is, it will make it higher). This correction is never used to make calcium levels lower, and it should never be used on ambulatory otherwise “healthy” folks.

Summary… in very sick people (hospitalized-for weeks sick) the measured calcium level should be INCREASED by taking account for a low body protein (albumin) level. That is the ONLY time this correction is used.

Additionally, we have learned in the podcast  – URINE, SERUM & IONIZED CALCIUM TESTS, VITAMIN D AND PURPOSE/VALUE OF SCANS AND IMAGING Posted: May 14, 2015 (22 minutes) with Dr Norman that ionized calcium is considered the “gold standard” for measuring calcium values. It is often ordered as the follow-up test when serum calcium is noted as being high. Calcium and parathyroid hormone levels should always be evaluated together and in relationship to one another.  Primary hyperparathyroid disease is diagnosed biochemically – through blood work. Therefore, obtaining a patients urine calcium is only of value in unique situations which is also discussed in the podcast.

Scans are not a proper diagnostic tool as many adenomas will simply NOT appear on a scan or image. Many surgeons however insist on seeing the adenoma on a scan or image prior to doing a surgery. This may be indicative that the surgeon is skilled enough to perform a focused surgery and that they do not intend to “explore”. Be aware that exploring creates scar tissue and can severely complicate matters for experts if a second surgery is required because a second adenoma was missed, or a perfectly good gland was removed inadvertently by an inexperienced surgeon instead of the offending adenoma. We offer a list of questions you may want to ask to help ensure the surgeon you select has the proper level of expertise to remove your parathyroid adenoma(s). Become informed!

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