Hypercalcemia laboratory findings

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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]


Routine panel is recommended for patients suspected of hypercalcemia to diagnosed the underlying cause.

Laboratory Findings

The following test may be done as a routine panel if a person is suspected of hypercalcemia:

Biochemical tests

Serum Calcium

  • An elevated serum calcium on routine biochemical screening in a asymptomatic patient should raise the suspicion of primary hyperparathyroidism.[1]
  • Measurement of total serum calcium with automatic techniques has similar or even more reliability than serum ionized calcium measurement.
  • An elevated serum calcium should be confirmed by repeat measurement.
  • 20% of patients with proven primary hyperparathyroidism have normal total calcium and elevated parathyroid hormone. Serum ionized concentration measurement is helpful in such cases.[2]
  • Some patients with primary hyperparathyroidism may have elevated concentration of serum parathyroid hormone with normal serum calcium, which is usually suggestive of normocalcemic primary hyperparathyroidism.[3] Causes of secondary hyperparathyroidism should be rules out for making the diagnosis of normocalcemic primary hyperparathyroidism. Normocalcemic primary hyperparathyroidism might represent the first symptomatic stage of primary hyperparathyroidism.[4]

Serum Parathyroid hormone

  • Method of choice for measuring intact parathyroid hormone include Immunoradiometric assay (IMRA) or Immunochemiluminescent assay (ICMA).[5]

24-Hour urinary calcium

Serum 1,25-dihydroxy vitamin D

  • May be used to differentiate between Familial hypercalciuric hypercalcemia (FHH) with primary hyperparathyroidism.[8][9]
  • Serum 1,25-dihydroxy vitamin D (calcitriol) concentration are significantly lower in FHH than primary hyperparathyroidism.


  1. Silverberg SJ, Bilezikian JP (1996). "Evaluation and management of primary hyperparathyroidism". J. Clin. Endocrinol. Metab. 81 (6): 2036–40. doi:10.1210/jcem.81.6.8964825. PMID 8964825.
  2. Glendenning P, Gutteridge DH, Retallack RW, Stuckey BG, Kermode DG, Kent GN (1998). "High prevalence of normal total calcium and intact PTH in 60 patients with proven primary hyperparathyroidism: a challenge to current diagnostic criteria". Aust N Z J Med. 28 (2): 173–8. PMID 9612524.
  3. Silverberg SJ, Lewiecki EM, Mosekilde L, Peacock M, Rubin MR (2009). "Presentation of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop". J. Clin. Endocrinol. Metab. 94 (2): 351–65. doi:10.1210/jc.2008-1760. PMC 5393372. PMID 19193910.
  4. Lowe H, McMahon DJ, Rubin MR, Bilezikian JP, Silverberg SJ (2007). "Normocalcemic primary hyperparathyroidism: further characterization of a new clinical phenotype". J. Clin. Endocrinol. Metab. 92 (8): 3001–5. doi:10.1210/jc.2006-2802. PMID 17536001.
  5. Endres DB, Villanueva R, Sharp CF, Singer FR (1991). "Immunochemiluminometric and immunoradiometric determinations of intact and total immunoreactive parathyrin: performance in the differential diagnosis of hypercalcemia and hypoparathyroidism" (PDF). Clin. Chem. 37 (2): 162–8. PMID 1993319.
  6. Marx SJ, Stock JL, Attie MF, Downs RW, Gardner DG, Brown EM, Spiegel AM, Doppman JL, Brennan MF (1980). "Familial hypocalciuric hypercalcemia: recognition among patients referred after unsuccessful parathyroid exploration". Ann. Intern. Med. 92 (3): 351–6. PMID 7356229.
  7. Marx SJ, Spiegel AM, Brown EM, Koehler JO, Gardner DG, Brennan MF, Aurbach GD (1978). "Divalent cation metabolism. Familial hypocalciuric hypercalcemia versus typical primary hyperparathyroidism". Am. J. Med. 6http://www.sciencedirect.com/science/article/pii/0002934378908148?via%3Dihub5 (2): 235–42. doi:10.1016/0002-9343(78)90814-8. PMID 686009.
  8. Law WM, Bollman S, Kumar R, Heath H (1984). "Vitamin D metabolism in familial benign hypercalcemia (hypocalciuric hypercalcemia) differs from that in primary hyperparathyroidism". J. Clin. Endocrinol. Metab. 58 (4): 744–7. doi:10.1210/jcem-58-4-744. PMID 6699136.
  9. Christensen SE, Nissen PH, Vestergaard P, Heickendorff L, Rejnmark L, Brixen K, Mosekilde L (2008). "Plasma 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and parathyroid hormone in familial hypocalciuric hypercalcemia and primary hyperparathyroidism" (PDF). Eur. J. Endocrinol. 159 (6): 719–27. doi:10.1530/EJE-08-0440. PMID 18787045.

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