Clinical Review Lesson of the week

Hypercalcaemia in cancer

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7522.954 (Published 20 October 2005) Cite this as: BMJ 2005;331:954
  1. Simon Conroy, clinical lecturer in geriatrics1 (simon.conroy@nottingham.ac.uk)1,
  2. Brendan O'Malley, consultant physician2
  1. 1Division of Rehabilitation and Ageing, Medical School, Queen's Medical Centre, Nottingham NG7 2UH
  2. 2Kettering General Hospital, Kettering NN16 8UZ
  1. Correspondence to: S Conroy
  • Accepted 2 August 2005

Introduction

The commonest cause of hypercalcaemia in hospitalised patients is malignancy, so the tendency is to presume that hypercalcaemia in a patient with cancer is related to malignancy. This may not be the case, however.

Case reports

Case 1

A 50 year old woman underwent a wide local excision and axillary node clearance for breast cancer in July 1999. She received postoperative chemo-radiotherapy and made a good recovery. A year later she presented with fatigue and distal paraesthesia. Her adjusted serum calcium concentration was 2.69 mmol/l (normal range 2.2-2.6). She was investigated for metastatic breast cancer, including a bone scan, and was advised that her cancer had recurred. Four months later, she remained anxious but well; her serum calcium was 2.71 mmol/l, and a paired serum parathyroid hormone concentration of 10.9 pmol/l (normal range 1.1-7.5) confirmed primary hyperparathyroidism. After careful follow-up, a left lower pole parathyroid adenoma was removed. The patient's …

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