Hypercalcaemia

Question 1

When should hypercalcaemia always be in the differential?

Answer 1

In patients with vague abdominal symptoms with KNOWN metastatic carcinoma, particularly those prone to spreading to bone

Question 2

Which metastatic cancers have a tendency to spread to the bone?

Answer 2

Thyroid
Breast + Bronchus
Kidney + Prostate
Myeloma

Question 3

What may cause hypercalcaemia?

Answer 3

Metastases to bone

Primary hyperparathyroidism

Question 4

What does hypercalcaemia present with/cause and what is the phrase to remember these?

Answer 4

• Bone metabolism
• Abdominal pain
• Psychiatric symptoms
• Increased frequency of calcium stones

“Bones, groans, moans, and stones”

Question 5

Treatment for hypercalcaemia + which drug class is immediately useful here?

Answer 5

Supportive - good rehydration
Identification and treatment of underlying cause where possible
- bisphosphonates may be used to lower serum calcium