Bedside assessment of hypercalcaemia

Hypercalcaemia results from either primary hyperparathyroidism (PHPT) or malignancy in approximately 90% of cases. PHPT mostly pursues an indolent course, often with evidence of chronicity such as renal stone disease. Malignancy hypercalcaemia is more often recent and aggressive in onset, with the tumour source obvious. The clinical history, physical examination and routine radiology emerge as useful bedside discriminants, compared with subsequent biochemical and hormonal tests.