Endocrinology & Metabolic

Hypercalcaemia

Hypercalcaemia is a raised albumin-adjusted serum calcium, most often caused by primary hyperparathyroidism or malignancy; PTH is the pivotal fork, while severe or rapidly symptomatic hypercalcaemia is an emergency requiring careful rehydration and specialist treatment.

Definition

Hypercalcaemia is an albumin-adjusted serum calcium above the laboratory reference range. It is classified by severity and speed of rise, and mechanistically as PTH-dependent or PTH-independent.

First principles

PTH is the diagnostic fork

A high calcium should suppress PTH. If PTH is raised or inappropriately within the reference range, think PTH-dependent disease: primary or tertiary hyperparathyroidism, or familial hypocalciuric hypercalcaemia (FHH). If PTH is suppressed, think PTH-independent disease, especially malignancy, vitamin-D-mediated disease, granulomatous disease or drugs.

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