Differential laboratory diagnosis of hypercalcemia

It is proposed that this review will adopt the following format: establishment of hypercalcemia. This demands a discussion of the problem of normal ranges, the usage of either total calcium or ionized calcium in making this decision and where total calcium is used whether adjustment of this value for serum protein concentration should be used and if so, the formulae which have been cited to perform this. Having established hypercalcemia why is it necessary to differentiate this? This will involve reviewing those clinical situations in which differentiation of hypercalcemia has been attempted and will include an attempt to produce an up to date indication of conditions in which hypercalcemia has been described. When hypercalcemia has been established the laboratory tests which have been further used to discriminate will be divided into single tests such as N- or C- terminal parathormone, 1,25- dihydroxycholecalciferol, cyclic AMP; the combination tests which have been used including phosphate clearance, chloride vs. bicarbonate etc. proceeding to those groups which have used discriminant function to help in the decision making; dynamic testing will also be discussed particularly with reference to steroid suppression but will also include other known suppressants such as Mithramycin and Calcitonin. A final section will be included attempting to assess overall the present state of art in differentiating laboratory diagnosis of hypercalcemia and will also attempt to highlight those areas which appear to be most fruitful areas of progress in the future.