Run the List Hypercalcemia
May 29, 2020
Dr. OP Hamnvik, an endocrinologist at Brigham and Women’s Hospital specializing in calcium and parathyroid disorders. A case of incidental high calcium sparks a clear walkthrough of calcium physiology. Short takes cover how to distinguish PTH-driven from non-PTH causes, which labs to trust, and options from surgery to inpatient medical management.
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PTH Dependent Versus Independent Causes
- Hypercalcemia causes split into PTH-dependent and PTH-independent categories guiding workup.
- Primary hyperparathyroidism (adenoma/hyperplasia) is the main outpatient cause; tertiary PTH issues occur with long-standing kidney failure.
Confirm Calcium Then Send PTH
- Confirm true hypercalcemia and then check PTH to direct the differential.
- Repeat total calcium with albumin (or measure ionized calcium) then send PTH, phosphorus, and often 25-hydroxyvitamin D.
Correct Calcium For Low Albumin
- Correct total calcium for low albumin before interpreting severity.
- Use +0.8 mg/dL correction per 1 g/dL albumin below 4 to estimate corrected calcium (e.g., corrected 11.6 for this patient).