Diagnosis of patients with raised serum calcium level in primary care, Sweden

Figures & data

Table I.  Primary hyperparathyroidism in population surveys in Scandinavia according to serum calcium levels and mode of diagnosis.

Author, year	Ref. no.	Population	Selection	No. of subjects	Age (years)	Design	Ca test	Ca limit (mmol/l)	pHPT diagnostics	pHPT prevalence	Follow-up [year]
Christensson, 1976	12	Swedish Stockholm	Employees of Stockholm City and County Council	15 903	20–63	Health survey	Ca	>2.78	Operation	0.36%	–
Palmér, 1987	10	Swedish Gävle	People > 25 year in a district of Gävle	16 401	>25	Population survey	Ca albumin-corrected	>2.60	Operation	0.21%	14
Lindstedt, 1992	13	Swedish Mölnlycke	People > 75 year in Mölnlycke	368	75–95	Health survey	Ionized Ca	>1.3	PTH	2.2%	–
Lundgren, 1997	14	Swedish Uppsala	Mammography screening (women)	5 202	55–75	Health survey	Ca	>2.55	PTH	2.1%	–
Jorde, 2000	9	Norwegian Tromsö	Inhabitants in Tromsö	27 159	25–75	Population survey	Ca	>2.59	PTH	0.25%	3
Dalemo, 2006	Present study	Swedish Tibro	Patients at the health centre	11 000	7–96	Primary care survey	Ca albumin-corrected	>2.55	PTH	0.22%^a	–

^aRate of patients attending primary healthcare. pHPT = Primary hyperparathyroidism. PTH = Parathyroid hormone. Ca = calcium. Ref. no.=Reference number.

Figure 1.  Total number of serum calcium analyses and the number of detected raised calcium levels (>2.55mmol/l), during 1992–2000 at Tibro Primary Health Care Centre, Sweden.

Figure 2.  Total number of parathyroid hormone, PTH, analyses, and number of detected raised PTH levels (>65 ng/l) during 1992–2000 at Tibro Primary Health Care Centre, Sweden.

Table II.  Albumin correction, parathyroid hormone analyses, further investigation, and diagnoses in 142 patients with different levels of hypercalcaemia found in Tibro primary care during 1995–2000.

Calcium (mmol/l)	Group I 2.56–2.60 n = 87		Group II 2.61–2.65 n = 27		Group III >2.65 n = 28		Total n = 142
	m	(SD)	m	(SD)	m	(SD)	m	(SD)
Age (years)	54	(±21)	61	(±22)	68	(±17)	58	(±21)
Serum calcium (mmol/l)	2.58	(±0.013)	2.63	(±0.015)	2.84	(±0.36)	2.64	(±0.19)
	n	(%)^a	n	(%)^b	n	(%)^c	n	(%)^d
Albumin
Controlled patients	57	(66)	24	(89)	26	(93)	107	(75)
Levels ≤ 33 g/l	0	(0)	0	(0)	9	(32)	9	(6)
Parathyroid hormone (PTH)
Controlled patients	15	(17)	10	(37)	8	(29)	33	(23)
Raised PTH levels > 65ng/l	6	(7)	4	(15)	4	(14)	14	(10)
Further investigation
Referred patients	13	(15)	6	(22)	14	(50)	33	(23)
No investigation	37	(43)	5	(19)	6	(21)	48	(34)
Diagnoses
PHPT	9	(10)	5	(19)	8	(29)^e	22	(15)^e
Cancer	1	(1)	–		3	(11)^e	4	(3)^e
Hypervitaminosis D	3	(3)	–		–		3	(2)
Sarcoidosis	–		1	(4)	–		1	(1)
Kidney disease	–		–		5	(18)	5	(3)
Lithium treatment	1	(1)	–		–		1	(1)
Thyroid disease	1	(1)	–		–		1	(1)
Skeletal disease	1	(1)	4	(15)	2	(7)	7	(5)
Unknown	71	(82)	17	(63)	11	(39)	99	(70)

^aPercentage of 87; ^bpercentage of 27; ^cpercentage of 28; ^dpercentage of 142; ^eone patient had both cancer and pHPT.

Table III.  Distribution of diagnoses (%) in studies of hypercalcaemia in health surveys, hospitals, and primary care.

Country	Norway	Sweden	Sweden	USA	UK	USA	Sweden
Reference	9	14	12	15	16	17	Present study
Decade	90s	90s	70s	60s	70s	60s	90s
S-Ca level mmol/l	2.6	2.55	2.78	NI	2.7	NI	>2.55
Population	HS	HS	HS	PC	H	H	PC
Number	366	188	95	61	469	57	142
PHPT	17	58	60	51	27	21	15
Cancer	–	–	2	31	54	65	2
Hypervitaminosis D	–	–	–	8	2	5	2
Sarcoidosis	–	–	1	–	–	–	1
Kidney disease	–	1	–	–	15	–	3
Lithium treatment	–	–	–	–	–	–	1
Milk alkali syndrome	–	–	–	7	–	–	–
Thyreoidea disease	–	–	4	3	1	–	1
Addison′s disease	–	–	–	–	–	2	–
Thiazide treatment	–	–	4	–	–	–	–
Skeletal disease	–	–	–	–	–	–	5
Unknown	83	41	29	–	1	7	70
	100%	100%	100%	100%	100%	100%	100%

HS = health survey; PC = primary care; H = hospital; NI = no information.