What follow-up tests are necessary after the initial diagnosis of hypercalcaemia to monitor the patient's condition?

After the initial diagnosis of hypercalcaemia, the necessary follow-up tests to monitor the patient's condition include:

• Annual measurement of serum albumin-adjusted calcium to monitor calcium levels.
• Annual monitoring of kidney function through estimated glomerular filtration rate (eGFR) or serum creatinine.
• Bone mineral density assessment by dual-energy X-ray absorptiometry (DXA) every 2 years, especially if primary hyperparathyroidism is confirmed or suspected.
• Renal imaging (ultrasound, X-ray, or CT) if renal stones are suspected or to assess for nephrocalcinosis.
• Urinary biochemical stone profile to assess the risk of renal stones.
• Cardiovascular risk assessment as part of ongoing monitoring.

Additional monitoring considerations include more frequent or specialist-led follow-up if symptoms of hypercalcaemia develop, if serum calcium rises significantly (≥0.25 mmol/L above normal or ≥2.85 mmol/L), if eGFR falls below 60 mL/min/1.73 m², or if complications such as osteoporosis or renal stones occur. For patients who have undergone parathyroid surgery, annual calcium checks are recommended, with specialist advice for those with complications.

Monitoring frequency and tests may be adjusted based on specialist advice, clinical judgement, and the underlying cause of hypercalcaemia (e.g., malignancy-associated hypercalcaemia may require more frequent monitoring of calcium and renal function).

Patients should also be advised to maintain adequate hydration and receive information and support regarding their condition.

References: ¹,²