How should I monitor a patient with hypercalcaemia after initiating treatment?

After initiating treatment for hypercalcaemia, monitoring should include regular assessment of serum calcium levels and the patient's clinical condition, with the frequency and extent of monitoring guided by specialist advice and clinical judgement.

For patients with primary hyperparathyroidism who have not had surgery or whose surgery was unsuccessful, arrange annual monitoring of albumin-adjusted serum calcium, estimated glomerular filtration rate (eGFR), and creatinine. Additionally, monitor bone mineral density by dual-energy X-ray absorptiometry (DXA) every 2 years, and consider spinal imaging if clinically indicated (e.g., height loss or back pain). Renal imaging should be arranged if renal stones are suspected. Cardiovascular risk assessment is also recommended.

For patients who have had successful parathyroid surgery, check calcium levels annually and seek specialist advice if complications such as osteoporosis or renal stones occur.

In cases of malignancy-associated hypercalcaemia, monitoring of serum calcium, eGFR, and creatinine should be arranged with frequency depending on specialist advice or clinical judgement, as hypercalcaemia often recurs within 1–4 weeks after treatment if the cancer is not actively treated.

Advise patients to maintain adequate oral hydration and monitor for symptoms of hypercalcaemia throughout follow-up.

If monitoring reveals rising calcium levels (e.g., an increase of 0.25 mmol/L or more above normal range or adjusted calcium ≥2.85 mmol/L), worsening symptoms, reduced eGFR (<60 mL/min/1.73 m2), renal stones, or osteoporosis, refer back to an endocrinologist or appropriate specialist for further assessment and management.