Your Path

  • Hypercalcemia


  • Primary hyperparathyroidism: Most common cause of hypercalcemia; Isolated parathyroid adenoma (80-85%);4 gland parathyroid hyperplasia (10-15%)
  • Malignancy: PTHrP production (e.g. squamous cell); direct invasion of bone/osteolytic lesions (e.g. myeloma, breast); increased conversion 25-oh to 1, 25-Oh vitamin D (lymphoma)
  • Vitamin D intoxication
  • Granulomatous disease (e.g. Sarcoid) increased conversion 25-oh to 1, 25-Oh vitamin D
  • Meds→ e.g. HCTZ, lithium, antacids→ milk alkali synd
  • Immobility - Ca2+ elevation usually mild
  • Other endocrinopathy related (rare): hyperthyroidism, pheochromocytoma, hyper or hypoadrenal states
  • Paget's disease; Familial hypocalcuric hypercalcemia (often + family hx; low 24h urine calcium)


  • Confusion, weakness, fatigue, abdominal pain (hyper Ca2+ induced pancreatitis, PUD, constipation, other), fractures, renal stones, polyuria
  • Higher calcium levels are associated w/symptoms (e.g. as reach 12 or greater)
  • Cancer tends to cause higher levels hypercalcemia; also symptoms related to bone pain (mets) and/or primary cancer (e.g. mass effect, f, c, sweats, etc)

Physical Exam Findings

  • If mild and from hyperparathyroidism then may have no findings
  • Confusion, hypovolemia w/higher levels
  • Mass or other abnormal exam findings based on primary cancer if malignancy related