Hypercalcaemia in hospital patients. Clinical and diagnostic aspects

Area of Science:

• Endocrinology
• Oncology
• Nephrology

Background:

• Hypercalcaemia is a common electrolyte disturbance in hospitalized patients.
• Identifying the underlying cause is crucial for appropriate management.
• Diagnostic approaches require evaluation for accuracy and efficiency.

Purpose of the Study:

• To determine the relative importance of various causes of hypercalcaemia.
• To assess the predictive value of diagnostic tests for hypercalcaemia etiology.
• To analyze diagnostic challenges in patients with initially unknown causes.

Main Methods:

• Retrospective analysis of 166 hospital inpatients with identified hypercalcaemia over one year.
• Investigation of 153 patients to determine the cause of hypercalcaemia.
• Evaluation of serum calcium, phosphate, chloride, and acid-base status as diagnostic markers.
• Application of multivariate analysis for improved diagnostic discrimination.

Main Results:

• Malignancy was the most common cause (89 cases), particularly breast and bronchial tumors, with 75% presenting with metastases.
• Primary hyperparathyroidism was identified in 51 patients, often with non-specific symptoms and infrequent renal stones (20%).
• Other causes were rare (9%). In initially undiagnosed patients, hyperparathyroidism (64%) and malignancy (32%) were predominant.
• Serum phosphate, chloride, and acid-base status were poor predictors; multivariate analysis improved discrimination but still had significant classification errors.

Conclusions:

• Malignancy and primary hyperparathyroidism are the leading causes of hypercalcaemia in hospitalized patients.
• Diagnostic tests like serum phosphate and chloride are unreliable; multivariate analysis offers some improvement but diagnostic challenges persist.
• Early identification of malignancy and hyperparathyroidism is essential, despite non-specific presentations in some cases.