Hypercalcemia diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]


Serum calcium levels is the study of choice for the diagnosis of hypercalcemia. However, a panel of tests may be required to reach the underlying cause of hypercalcemia.

Diagnostic Study of Choice

Study of choice

  • Serum calcium levels is the study of choice for the diagnosis of hypercalcemia.
  • However, a panel of tests may be required to reach the underlying cause of hypercalcemia.

Diagnostic Approach

Repeat (Check ionized calcium or calcium corrected for albumin)
Hypercalcemia confirmed
Measure intact parathyroid hormone (PTH)
Mildly ↑ PTH
Urinary calcium creatinine ratio
Measure parathyroid hormone-related protein (PTHrP) and vitamin D metabolites
↑ serum phosphate
History of renal transplantation
↓/Normal phosphate levels
↑ Urinary calcium creatinine ratio
↓ Urinary calcium creatinine ratio
Tertiary hyperparathyroidism
Primary hyperparathyroidism
Familial hypocalciuric hypercalcemia
1,25-dihydroxy vitamin D
25-hydroxy vitamin D
1,25-dihydroxy vitamin D
Normal PTHrP and vitamin D metabolites
Humoral hypercalcemia of malignancy
Chest X-ray, ACE levels
Hypervitaminosis D
History of high milk intake,
excess calcium intake for treating osteoporosis or dyspepsia
Serum protein electrophoresis
Check medications
Check for malignancies
Bilateral hilar lymphadenopathy, ↑ ACE levels
Milk-alkali syndrome
Multiple myeloma
Breast cancer
Lithium induced hypercalcemia
Thiazide diuretic induced hypercalcemia


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