Hypercalcaemia

I saw a patient today with a recently diagnosed Paget's disease. He thinks that he has had symptoms for years but none of the GPs picked it up despite multiple abnormal ALPs. Eventually it was picked up by a GP registrar when he presented with palpitations and she ordered a Calcium, Magnesium and Phosphate. Looking back to my practice, I always forget to order calcium when people presented with palpitations. When I remembered to order them, I don't think I have ever had one came back elevated. The followings are just some key points on Calcium homeostasis and hypercalcaemia.

Key points:

- Common presentations can be summarised as "Bones, stones, groans and psychic moans."
- Causes of metastatic calcification can be summarised using a mnemonic, " Parathormone"

• Parathormone (PTH) increase and causes of Ca increase eg. Sarcoidosis 
• Amyloidosis 
• Renal failure (relates to increase PO4)
• Addison's disease (adrenal calcification)
• TB nodes; Toxoplasmosis (CNS)
• Histoplasmosis (e.g. in lung)
• Overdose in vitamin D
• Raynaud's - associated diseases , e.g. SLE; CREST; Dermatomyositis
• Muscle primaries/leiomyosarcomas
• Ossifying metastases (osteosracoma) or ovarian mets
• Nephrocalcinosis
• Endocrine tumours (e.g. gastrinoma)

- a basic flowchart from oxford handbook of clinical medicine, I think this is a good place to start.

Reference:
Oxford handbook of clinical medicine 8th edition