Intended for healthcare professionals

Clinical Review Lesson of the week

Hypercalcaemia in cancer

BMJ 2005; 331 doi: (Published 20 October 2005) Cite this as: BMJ 2005;331:954
  1. Simon Conroy, clinical lecturer in geriatrics1 (,
  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


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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