Understanding Hypercalcaemia: Symptoms, Diagnosis, and Investigations

Hypercalcaemia, characterized by elevated levels of calcium in the blood, is often discovered incidentally during routine blood tests. While many cases are asymptomatic, persistent hypercalcaemia can lead to ectopic calcification, which may be evident on plain radiographs in various organs, including the heart, joints, and kidneys. In more rare instances, the liver and pancreas can also be affected. It is important to recognize that hypercalcaemia linked to parathyroid hormone-related peptide (PTHrP) is typically a late manifestation of malignancy.

The symptoms of hypercalcaemia can vary widely, ranging from fatigue and muscle weakness to more severe complications such as bone fractures and convulsions. Common signs include increased thirst, frequent urination, abdominal pain, and mood disturbances. Understanding these symptoms is crucial for early identification and management of the condition, as severe cases can lead to life-threatening situations.

When investigating hypercalcaemia, healthcare professionals usually begin with measuring serum calcium levels. If there is uncertainty, a fasting blood sample can help minimize false elevations. Additional tests may be performed to determine the underlying cause, including assessing serum phosphate and parathyroid hormone (PTH) levels, as well as conducting imaging studies like neck ultrasounds and DEXA scans to evaluate bone health.

For diagnosing primary hyperparathyroidism, specific tests can reveal characteristic patterns. A decrease in serum phosphate and an increase in urinary calcium can indicate this condition. Imaging techniques such as CT or MRI might be necessary when surgery is considered, particularly if the adenoma is not localized. Additionally, investigating potential malignancies can involve chest X-rays, prostate examinations, and mammograms, among other approaches.

Prior to the advent of automated biochemical analyses, hypercalcaemia due to primary hyperparathyroidism was more prevalent and presented with distinct skeletal changes visible on X-rays. While this severe presentation is now less common, DEXA scans remain essential for assessing bone mineralization and fracture risk in individuals with hypercalcaemia.

In summary, hypercalcaemia is a complex condition that requires thorough investigation and interpretation of various clinical and laboratory findings. Awareness of its symptoms and potential complications can lead to timely diagnosis and management, improving patient outcomes.