The diagnosis and management of hypercalcaemia

Hypercalcaemia is a relatively common clinical problem with a wide spectrum of presentations. This review provides an overview of the diagnosis and management of hypercalcaemia, and recent developments in drug therapy.

A non-systematic review of the English-language literature on various aspects in the management of hypercalcaemia was conducted.

Increasingly, more patients with asymptomatic or minimally symptomatic disease are being detected. Appropriate evaluation of hypercalcaemia requires a careful elucidation of the underlying causes, the commonest being primary hyperparathyroidism and malignancy. The decision to treat and extent of treatment depends on factors such as the degree of hypercalcaemia, severity of symptoms, and the underlying cause. Several options are readily available to lower serum calcium levels. In the setting of acute, symptomatic hypercalcaemia, general measures such as saline rehydration and loop diuretics, and more specific measures including bisphosphonates (e.g. clodronate, pamidronate, ibandronate and zoledronate), calcitonin, mithramycin, gallium, glucocorticoids and dialysis, could be utilised. Definitive correction of the underlying cause, such as surgery for primary hyperparathyroidism or anti-tumour therapy, is important in controlling chronic hypercalcaemia. Medical therapy (estrogen, alendronate and raloxifene) is available to control bone sequelae in asymptomatic, mild hyperparathyroidism where surgery is not indicated.

The therapeutic approach to hypercalcaemia should be tailored to the clinical setting. Developments in the understanding of the pathophysiological processes and the increasing availability of more powerful therapeutic options would help in achieving good outcomes in the management of acute and chronic hypercalcaemia.