Hypercalcemia: When to suspect and refer for testing

Ally Prebtani, MD, is a professor of medicine in the Division of Endocrinology and Metabolism at McMaster University.

When should primary care physicians suspect hypercalcemia? Are there symptoms that should prompt the evaluation of calcium levels?

These days, hypercalcemia, especially in an outpatient setting, is asymptomatic and often detected when patients come in with very nonspecific symptoms such as fatigue—just feeling tired and lethargic.

But sometimes they may have symptoms. Especially if the calcium level is very high or more acute, they may have symptoms such as something we used to call “moans, groans, bones, and stones.” So, psychological changes, depression, abdominal pain, nausea, vomiting, kidney stones, maybe another manifestation, and bony pains. Sometimes, like I said—most of the time—they’re actually asymptomatic. But these are some of the known symptoms you should watch out for and investigate for hypercalcemia.

Another one is if they have had a fracture; or low density on a bone mineral density scan would be another reason to suspect [hypercalcemia].

Another one is having a high creatinine level, which can also indicate that there may be hypercalcemia going on.