A raised blood calcium level should not be left unexplained. Dr Syed Kazmi, Consultant Endocrinologist, provides the full work-up for high calcium and primary hyperparathyroidism, decides between surgical referral and structured surveillance using recognised criteria, and manages low calcium and hypoparathyroidism — for adults anywhere in Ireland, in person in Naas or by video.
The Work-Up
A persistently raised albumin-adjusted calcium is investigated systematically rather than watched indefinitely.
What's Managed
Surgery or Surveillance
Parathyroidectomy is the only cure for primary hyperparathyroidism and is recommended when there are symptoms such as kidney stones or fragility fractures, or when internationally agreed thresholds are met — calcium more than 0.25 mmol/L above the upper limit of normal, age under 50, reduced kidney function, a bone density T-score of −2.5 or below, a vertebral fracture, a high 24-hour urine calcium, or stones or calcification on kidney imaging. Where none of these apply, monitoring calcium, kidney function and bone density on a defined schedule is a recognised and safe alternative. Dr Kazmi sets out which applies to you and, where surgery is indicated, refers to an endocrine surgeon with the localisation work-up already completed.
Related
Bone density, fracture-risk scoring and treatment — often assessed alongside calcium disorders.
View page →The scan used to assess the skeletal effect of hyperparathyroidism.
View page →The full endocrinology service — thyroid, adrenal, pituitary and more.
View page →Video and phone endocrinology consultations, Ireland-wide.
View page →Frequently Asked Questions
By far the commonest cause of a persistently raised calcium in an otherwise well person is primary hyperparathyroidism, where one or more of the four parathyroid glands becomes overactive and produces too much parathyroid hormone (PTH). The next most common cause overall is malignancy, which usually produces a different biochemical pattern and presents differently. Other causes include high vitamin D or calcium intake, certain medicines (thiazide diuretics, lithium), thyroid overactivity, prolonged immobility, granulomatous conditions such as sarcoidosis, and the inherited condition familial hypocalciuric hypercalcaemia. The pattern of calcium, PTH, vitamin D and urine calcium usually distinguishes them.
The diagnosis rests on a raised albumin-adjusted serum calcium together with a parathyroid hormone level that is high, or is within the reference range but inappropriately so for the calcium level. Dr Kazmi confirms it on repeat testing, checks vitamin D and kidney function, measures a 24-hour urine calcium to exclude familial hypocalciuric hypercalcaemia, and assesses the effect on the body with a DEXA bone density scan and imaging of the kidneys for stones or calcification. Localisation scans such as ultrasound and sestamibi are arranged when surgery is being considered, not to make the diagnosis.
Not always. Parathyroidectomy is the only cure and is clearly recommended when there are symptoms such as kidney stones or fragility fractures, or when internationally agreed criteria are met: calcium more than 0.25 mmol/L above the upper limit of normal, age under 50, reduced kidney function, a bone density T-score of −2.5 or below, a vertebral fracture, a high 24-hour urine calcium, or kidney stones or calcification on imaging. Where none of these apply, structured monitoring of calcium, kidney function and bone density is a recognised and safe alternative, and Dr Kazmi will talk through which path fits your situation.
Many people have no symptoms and are found on a routine blood test. When symptoms do occur they can include tiredness and low mood, poor concentration, excessive thirst and urination, constipation, bone and joint aches, kidney stones, and — with higher calcium levels — nausea and abdominal pain. Because these are non-specific, the biochemical picture matters more than symptoms alone in deciding whether and how to treat.
Most primary hyperparathyroidism is sporadic and involves a single benign parathyroid adenoma. A minority is part of an inherited syndrome — multiple endocrine neoplasia types 1, 2A and 4, hyperparathyroidism-jaw tumour syndrome, or familial isolated hyperparathyroidism — which is more likely when it occurs at a young age, involves more than one gland, or runs in the family alongside other endocrine tumours. Dr Kazmi assesses this and arranges genetic testing and family screening where the features suggest an inherited cause.
The clinic also manages the opposite problem: low calcium and underactive parathyroid glands, most often after thyroid or neck surgery, and other causes of hypocalcaemia. Management covers calcium and activated vitamin D (alfacalcidol or calcitriol) replacement, magnesium correction where relevant, monitoring to keep calcium in a safe low-normal range, and advice on recognising and treating acute symptoms.
Yes. Consultations are available by secure video or phone to adults anywhere in the Republic of Ireland, most weekday evenings between 16:00 and 19:00. In-person appointments run in Naas, Co. Kildare on Saturdays and Sundays. Where a physical examination or an on-site test is needed, the in-person visit is arranged as a follow-up to the video consultation rather than instead of it.
No. Both self-referral and GP referral are accepted for all consultations. A GP referral letter is useful because it provides your history, medication list and recent results, and can be sent securely to the clinic through Healthmail, but it is not required to book.
An initial consultant appointment is €230 and a follow-up is €150, the same whether you are seen in person in Naas or online by video. This is a self-pay clinic. Patients with private health insurance may be able to claim outpatient consultant benefits depending on their policy, and should confirm eligibility directly with their insurer before booking.
Book Today
In person in Naas at weekends, or by video weekday evenings. €230 initial, €150 follow-up.