Hypercalcaemia

Causes

Appropriate Tests

 

Hypercalcaemia may need to be verified and common artefacts excluded, by collecting a fasting blood specimen without using a tourniquet (stasis-free); see Table 1.

Calcium: total and corrected; ionised if presence of true hypercalcaemia is doubtful. Albumin.

Further assessment should include Phosphate, Electrolytes, Creatinine, Urea, Alkaline phosphatase, Full blood count, Erythrocyte sedimentation rate.

Artefactual result

See above, and Table 1.

Hyperparathyroidism

Parathyroid hormone.

Carcinoma

 

  • With bone metastases

Review clinical findings, Full blood count, Blood film.

See also Leucoerythroblastic anaemia.

  • Without bone metastases (humoral hypercalcaemia)

Review clinical findings for evidence of primary tumour.

Parathyroid hormone related protein, if diagnosis uncertain or if indicated as a tumour marker for monitoring therapy.

  • Lung

 

  • Kidney

 

  • Pancreas

 

Plasma cell myeloma

 

Lymphoma (classification)

 

Vitamin D toxicity

Vitamin D (25-hydroxy) if vitamin D2 or D3 taken; Vitamin D 1,25-dihydroxy if calcitriol taken.

Vitamin A toxicity

Vitamin A.

Granulomas, especially

  • Sarcoidosis

 

Familial hypocalciuric hypercalcaemia

Calcium urine.

High bone turnover states, especially

  • Immobilisation
  • Hyperthyroidism

 

References

See also Pathology Decision Support Tool:  Hypercalcaemia