Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For a patient with asymptomatic hypercalcaemia, the recommended management strategies include:
- Initial assessment and investigation: Perform a full clinical assessment and arrange initial investigations to establish the probable cause of hypercalcaemia, including measuring albumin-adjusted serum calcium and parathyroid hormone (PTH) levels if indicated. Repeat calcium measurement at least once to confirm persistence NICE CKS,NICE NG132.
- Review and modify medications: Review medications that may exacerbate hypercalcaemia, such as thiazide diuretics, lithium, calcium, and vitamin D supplements, and consider stopping them if appropriate NICE CKS.
- Referral to specialist: Refer to an appropriate specialist (e.g., endocrinologist) unless a reversible cause is identified and corrected with normalization of calcium levels. Referral urgency depends on calcium level severity and clinical context NICE CKS,NICE NG132.
- Monitoring: Arrange monitoring of calcium levels and clinical condition in primary care, with repeat calcium testing at least 3 weeks after any medication changes. Advise maintaining adequate oral hydration NICE CKS.
- Management of primary hyperparathyroidism: If primary hyperparathyroidism is suspected (e.g., raised calcium with raised or inappropriately normal PTH), refer to an endocrinologist for further diagnostic workup and management, including consideration of surgery even if asymptomatic NICE CKS,NICE NG132.
- Non-surgical management: For those unsuitable for surgery or who decline it, consider medical options such as cinacalcet or bisphosphonates based on calcium levels and fracture risk, under specialist guidance NICE NG132.
In summary, asymptomatic hypercalcaemia requires careful evaluation to identify the cause, modification of contributing factors, specialist referral for diagnosis and management, and ongoing monitoring in primary care NICE CKS,NICE NG132.