Differential Diagnosis of Hypercalcaemia

Non malignant causes of hypercalcaemia include:

  • Chronic renal failure
  • Endocrine disorders (hyperthyroidism, phaeochromocytoma, Addison’s disease)
  • Familial hypocalciuric hypercalcaemia
  • Immobilisation
  • Laboratory artifact due to altered albumin concentration or serum pH
  • Medications (vitamin A toxicity [dietary fads, isotretinoin overdose, multivitamin overdose], oestrogens, antioestrogens, thiazides, lithium)
  • Milk-alkali syndrome
  • Primary hyperparathyroidism
  • Vitamin D toxicity
  • Granulomatous disease (sarcoidosis, tuberculosis)

Malignancies causing hypercalcaemia

Table 1: Tumours most often associated with hypercalcaemia [5]



Multiple myeloma 40 to 50%
Breast >20%
Lung Usually squamous cell
Squamous cell cancers of head, neck, oesophagus and thyroid Rarely