This includes the commonest underlying diagnosis: primary hyperparathyroidism, and all other causes of hypercalcaemia.

General examination

To diagnose hypercalcaemia a detailed and full general examination is mandatory in the initial assessment of all patients. Particular attention should be made of the neck, lymph nodes, and gastrointestinal system to seek underlying causes of hypercalcaemia.

Cardiorespiratory status

Examination of the chest may reveal signs of sarcoidosis, tuberculosis or malignancy.

Prior to considering surgery, thorough cardiac assessment and fitness for anaesthetic should also be assessed. 


Seeking underlying malignancy.

Neck and lymph nodes

Seeking underlying malignancy as well as thyroid and parathyroid anatomy.


Seeking evidence of underlying renal disease or haematuria.

Thyroid status

Seeking underlying thyrotoxicosis.

Examine for signs of Addison's disease

Increased pigmentation or postural hypotension may indicate underlying Addison's disease.