HYPERCALCAEMIA
Published 02 June 2015)
BMJ 2015;350:h2723.

Primary hyperparathyroidism and malignancy are the two most common causes of increased serum calcium levels

The diagnosis of hypercalcaemia is made when the corrected serum calcium concentration is 2 standard deviations above the mean of values found in people with normal calcium levels, in at least two samples at least one week apart over a period of three months

The presence of high or not adequately suppressed serum parathyroid hormone levels should point the diagnosis towards hypercalcaemia of parathyroid origins

Mild hypercalcaemia is usually caused by primary hyperparathyroidism, the treatment for which is typically surgery; those aged 50 or more with serum calcium levels <0.25 mmol/L above the upper limit of normal and without end organ damage may be followed up conservatively. Treatment with a calcimimetic agent, cinacalcet, is an option in selected cases

Severe hypercalcaemia requires admission to hospital and treatment with aggressive intravenous hydration and bisphosphonates along with treatment of the underlying disease

Hypercalcaemia is a common finding in the setting of primary care, as well as in emergency departments,and patients admitted to hospital.

Primary hyperparathyroidism and malignancy are the two most common causes of increased serum calcium levels, together accounting for about 90% of all cases.
The remaining 10% represent an important figure, and thus the need to consider other disorders in the evaluation of patients with hypercalcaemia.

G Mohan.