Endocrine Abstracts

Background: Primary hyperparathyroidism (PHP) is the commonest cause of hypercalcaemia, with an annual incidence rate (AIR) of 4/100 000 and peak age incidence of 50–60 years. Our hospital serves a population with age ≥18 of around 500 000. A corrected calcium (cCa) ≥3.00 mmol/l is a critical phoning limit in our biochemistry laboratory.

Aim: To assess the incidence of hypercalcaemia in the community, the referral pattern of hypercalcaemia in the primary care and the laboratory practice on phoning out results.

Methods: This retrospective audit included bone profiles (cCa, phosphate and alkaline phosphatase) from primary care between July 2010 and November 2012. Those with cCa <2.8 mmol/l, aged <18 years and known to have hypercalcaemia previously were excluded.

Results: Overall 22 patients had cCa ≥2.8 mmol/l (19F) aged 59 (36–82) years. 68% (n=15) were referred specifically for hypercalcaemia, 23% (n=5) for other reasons and 9% (n=2) were not referred. 32% had PHP, 18% were on Ca/vitamin D supplements, 14% had malignancies and 36% had other causes (including secondary hyperparathyroidism) or no known cause. Vitamin D was requested in 50% and parathyroid hormone in 60% but none had a urine calcium request. All cCA ≥3.00 mmol/l were phoned by the laboratory. Our study led to referral and diagnosis of a patient with PHP who was not investigated since 2010.

Conclusions: The AIR of hypercalcaemia was 1.9/100,000. There is a wide variation in the referral practice for hypercalcaemia in the community. A guideline on hypercalcaemia management for the primary care may improve patient outcome.