Hypercalcemia Evaluation
1) Clinical clues
- Is the patient symptomatic?
- Family history?
- Have you done a careful med rec?
2) PTH
- Frankly high? → Primary hyperapara most likely
- Mid range/ULN? → Primary hyperpara vs. FHH — check the urine Ca++ (<100 mg/day or FeCa <1 %)
- Low normal?
• PTHrp
• 25 OH VitD & 1,25 OH Vit D
• If all normal, move on to SPEP/SFLC, TSH, VitA
- BWH Medicine Chiefs @BrighamChiefs
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