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Hypercalcaemia - Management
Basis for recommendation
Check with the local biochemistry laboratory for reference range
- The recommendation to check with the local biochemistry laboratory for the reference range of normal values for parathyroid hormone (PTH) is made on the basis that several different methods are available for measuring PTH [Klee et al, 1988; Pagana and Pagana, 2010]. Published reference ranges vary considerably.
High PTH level
PTH levels within the reference range
- The recommendations in relation to PTH levels within the reference range take into account inconsistency in the published literature, and are a safe compromise given the uncertainty.
- Four narrative reviews state that normal, high-normal, or 'inappropriately detectable' PTH levels indicate primary hyperparathyroidism, or (less commonly) tertiary hyperparathyroidism or familial hypocalciuric hypercalcaemia [Ralston, 1992; Carroll and Schade, 2003; Selby, 2003; DTB, 2010].
- One narrative review states that, if PTH levels are normal, cancer should be excluded [Murphy et al, 2006].
Low PTH level
Be aware that hyperparathyroidism may coexist with cancer
- This recommendation is based on expert opinion from a narrative review [Ralston, 1992].
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