Hypercalcemia - Clinical Symptoms and Diagnostic Testing

Hypercalcemia manifests through a diverse range of clinical symptoms affecting the gastrointestinal, renal, neuromuscular, and cardiovascular systems. While many patients remain asymptomatic at mild levels, serum calcium concentrations above 12 mg/dL often lead to severe constipation, pancreatitis, and polyuria due to decreased renal concentrating ability. Chronic elevation contributes to nephrolithiasis and osteoporosis, increasing the risk of fragility fractures. Diagnostic accuracy requires adjusting total calcium for albumin levels—adding 0.8 mg/dL to the calcium value for every 1 g/dL drop in albumin—or measuring ionized calcium directly to identify the active form. Beyond basic metabolic panels, evaluating bone mineral density and parathyroid hormone levels is essential for identifying underlying etiologies like primary hyperparathyroidism. Although cardiac implications such as shortened QT intervals and vascular calcification are noted, clinical focus remains on managing systemic complications and promoting weight-bearing exercise to mitigate bone loss.