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).
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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