Summary
Definition
History and exam
Key diagnostic factors
- history of malignancy
Other diagnostic factors
- normal physical exam
- poor skin turgor and/or dry mucous membranes
- confusion
- fatigue
- constipation
- loss of appetite
- nausea
- polyuria
- polydipsia
- bone pain
- use of hypercalcemia-inducing medication
- stupor
- coma
Risk factors
- nonmetastatic malignancy
- metastatic skeletal involvement
- lymphoma
Diagnostic tests
1st tests to order
- total serum calcium
- serum ionized calcium
- serum albumin
- comprehensive metabolic panel
- resting ECG
- serum intact parathyroid hormone
- serum parathyroid hormone-related peptide
- serum phosphorus
- serum calcitriol (1,25-dihydroxyvitamin D)
- serum 25-hydroxyvitamin D
Tests to consider
- skeletal survey
- chest x-ray
Treatment algorithm
mild hypercalcemia or asymptomatic moderate hypercalcemia
symptomatic moderate or severe hypercalcemia: without advanced kidney disease
symptomatic moderate or severe hypercalcemia: with advanced kidney disease
Contributors
Authors
Albert Shieh, MD
Assistant Professor of Medicine
Division of Geriatric Medicine
Department of Medicine
University of California, Los Angeles
Los Angeles
CA
Disclosures
AS declares that he has no competing interests.
Dorothy Martinez, MD
Clinical Professor of Medicine
Division of Endocrinology
Department of Medicine
University of California, Los Angeles
Los Angeles
CA
Disclosures
DM declares that she has no competing interests.
Peer reviewers
Ken C. Chiu, MD, FACE
Professor
Endocrinology Fellowship Training Program
Department of Clinical Diabetes, Endocrinology, and Metabolism
City of Hope National Medical Center
Duarte
CA
Disclosures
KCC declares that he has no competing interests.
Richard Quinton, MD
Consultant and Senior Lecturer
Endocrine Unit
Newcastle University and Royal Victoria Infirmary
Newcastle-upon-Tyne
UK
Disclosures
RQ has been reimbursed by Amgen, the manufacturer of Cinacalcet, for attending a conference and for giving an educational seminar (total under £1,200 over past 3 years).
References
Key articles
Cancer Institute NSW. Hypercalcaemia of malignancy (HCM). Jul 2019 [internet publication].Full text
Guise TA, Wysolmerski JJ. Cancer-associated hypercalcemia. N Engl J Med. 2022 Apr 14;386(15):1443-51. Abstract
Horwitz MJ. Chapter 84: Non-parathyroid hypercalcemia. In: Bilezikian JP, ed. Primer on the metabolic bone diseases and disorders of mineral metabolism. 9th ed. Washington, DC: American Society of Bone and Mineral Research; 2018:639-45.
El-Hajj Fuleihan G, Clines GA, Hu MI, et al. Treatment of hypercalcemia of malignancy in adults: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2023 Feb 15;108(3):507-28.Full text Abstract
Stewart AF. Clinical practice. Hypercalcemia associated with cancer. N Engl J Med. 2005 Jan 27;352(4):373-9. Abstract
Alberta Provincial Tumour Council. Oncologic emergencies: a guide for family physicians. Sep 2014 [internet publication].Full text
Society for Endocrinology. Emergency management of acute hypocalcaemia in adult patients. Sep 2016 [internet publication].Full text
Horwitz MJ, Hodak SP, Steward AF. Non-parathyroid hypercalcemia. In: Rosen CJ, ed. Primer on the metabolic bone diseases and disorders of mineral metabolism. 8th ed. Washington, DC: American Society of Bone and Mineral Research; 2013:562-71.
Major P, Lortholary A, Hon J, et al. Zoledronic acid is superior to pamidronate in the treatment of hypercalcemia of malignancy: a pooled analysis of two randomized, controlled clinical trials. J Clin Oncol. 2001 Jan 15;19(2):558-67. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Primary hyperparathyroidism
- Hyperthyroidism
- Adrenal insufficiency
More DifferentialsGuidelines
- Cancer guidelines: symptom management. Oncologic emergencies
- Treatment of hypercalcemia of malignancy in adults: an Endocrine Society clinical practice guideline
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