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Test Findings




    • Look For

    • Total calcium >2.60 mmol/L
    • Ionised calcium >1.35 mmol/L


    • Causes of Hypercalcaemia

    • Malignancy - local osteolysis, humoral hypercalcaemia of malignancy, multiple myeloma
    • Hyperparathyroidism (primary / secondary / tertiary)
    • Endocrine - thyrotoxicosis, Addison’s disease
    • Granulomatous disease - sarcoidosis, tuberculosis
    • Prolonged immobilisation
    • Drugs - calcium supplements, vitamin D, vitamin A, thiazides, lithium, oestrogens, anti-oestrogens, progestins
    • Total parenteral nutrition (TPN)
    • Familial hypercalcaemia-hypercalciuria (FHH)

Clinical Features

    • Signs and Symptoms

    • Renal (‘stones’) - nephrolithiasis, nephrocalcinosis, nephrogenic diabetes insipidus
    • GI (‘groans’) - nausea, reflux, peptic ulcers, pancreatitis, constipation
    • CNS (‘moans’) - lethargy, depression, confusion, memory loss, coma
    • MSK (‘bones’) - osteopaenia, bone pain, pathologic fractures
    • Cardiovascular - hypertension, shortened QT


    • Further Investigations

    • Check the patient’s PTH
    • If not elevated - check the PTH-related peptide (PTHrp), 25-hydroxy-vitamin D and 1,25-dihydroxy-vitamin D levels
    • Elevated alkaline phosphatase (ALP) is suggestive of local osteolysis
    • Specific tests such as TFTs, cortisol and myeloma screen may be useful
    • Approach
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