Hypercalcemia Workup

An elevated calcium result is a finding, not a diagnosis. First decide whether the elevation is real; then ask whether PTH is appropriately suppressed. That single physiologic question separates PTH-dependent disease—most often primary hyperparathyroidism—from the PTH-independent causes that require a different test pathway. The renal clues are not incidental: stones, nephrocalcinosis, declining eGFR, and polyuria with dehydration show how calcium excess is affecting the patient and can change urgency or surgical planning. For a Canadian NP, this workup includes ordering and interpreting laboratory investigations and ordering permitted diagnostic imaging within the applicable provincial or territorial standards. The NP is responsible for reviewing results, communicating the diagnosis, prescribing within scope, and arranging follow-up. Biochemical confirmation comes before parathyroid localization; a scan can show where an abnormal gland may be, but cannot establish why the calcium is high.