Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 186: A 45-Year-Old with Elevated Calcium
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Mar 12, 2026 A 45-year-old with incidental high calcium sparks a clinical workup of hypercalcemia. They explore lab correction for albumin and confirm ionized calcium elevation. The conversation covers calcium homeostasis, PTH versus PTHrP mechanisms, effects of lithium and familial hypocalciuric hypercalcemia, and malignancy-related pathways like squamous cell carcinoma secreting PTHrP.
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Correct Calcium For Albumin First
- Do correct total calcium for albumin before diagnosing hypercalcemia.
- Add 0.8 mg/dL to total calcium for each 1 g/dL albumin below 4.0, or measure ionized calcium when available.
Measure PTH To Differentiate Causes
- Do obtain a parathyroid hormone (PTH) level next to distinguish causes of hypercalcemia.
- Elevated or inappropriately normal PTH points to primary hyperparathyroidism or FHH, while suppressed PTH suggests malignancy.
PTH Patterns In Parathyroid Disorders
- Primary hyperparathyroidism and MEN syndromes cause elevated or inappropriately normal PTH despite hypercalcemia.
- Familial hypocalciuric hypercalcemia (FHH) shows lifelong mild hypercalcemia with >99% renal calcium reabsorption and often requires genetic testing.
