{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T11:02:20Z","timestamp":1774263740337,"version":"3.50.1"},"reference-count":22,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T00:00:00Z","timestamp":1774051200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Severe hypercalcemia is a life-threatening condition requiring immediate treatment alongside a systematic evaluation to identify the underlying cause. Although malignancy is a common etiology among hospitalized patients, alternative causes must be considered to guide targeted therapy, as illustrated in these cases. The first case involved a 31-year-old postpartum woman with corrected calcium levels of 14.5 mg\/dL and suppressed PTH. Hypercalcemia resolved after tapering and temporary cessation of breastfeeding, consistent with lactation-associated hypercalcemia that is likely PTHrP-mediated. The second case describes a 30-year-old woman who presented with hypotension, hypercalcemia, hyperphosphatemia, and low PTH. A systematic evaluation revealed severe glucocorticoid deficiency consistent with primary adrenal insufficiency (Addison\u2019s disease). The final case featured a 47-year-old man with severe symptomatic hypercalcemia (18.5 mg\/dL) and markedly elevated PTH. Imaging revealed a 3 cm parathyroid tumor. Selective parathyroidectomy produced a rapid intraoperative PTH decline, and pathology supported parathyroid adenoma rather than carcinoma. Together, these cases highlight that symptomatic severe hypercalcemia is a medical emergency warranting prompt clinical intervention, followed by an early PTH-based stratification to direct a focused, stepwise diagnostic workup and definitive management.<\/jats:p>","DOI":"10.3390\/jcm15062412","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T09:48:42Z","timestamp":1774259322000},"page":"2412","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Malignancy: Clinical Insights from Three Cases of Severe Hypercalcemia"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9613-2402","authenticated-orcid":false,"given":"Shani","family":"Ben Dori","sequence":"first","affiliation":[{"name":"Department of Internal Medicine A, Meir Medical Center, 59 Tchernichovsky St, Kfar Saba 4428164, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noor","family":"Kabaha","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine A, Meir Medical Center, 59 Tchernichovsky St, Kfar Saba 4428164, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4592-0862","authenticated-orcid":false,"given":"Amer","family":"Abu Husseine","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine A, Meir Medical Center, 59 Tchernichovsky St, Kfar Saba 4428164, Israel"},{"name":"Cardiology Department, Meir Medical Center, Kfar Saba 4428164, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6607-6132","authenticated-orcid":false,"given":"Eilam","family":"Rabina","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine A, Meir Medical Center, 59 Tchernichovsky St, Kfar Saba 4428164, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liat","family":"Barzilay Yoseph","sequence":"additional","affiliation":[{"name":"Endocrinology Institute, Meir Medical Center, Kfar Saba 4428164, Israel"},{"name":"Gray School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pnina","family":"Rotman-Pikielny","sequence":"additional","affiliation":[{"name":"Endocrinology Institute, Meir Medical Center, Kfar Saba 4428164, Israel"},{"name":"Gray School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin H.","family":"Ellis","sequence":"additional","affiliation":[{"name":"Gray School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel"},{"name":"Hematology Institute, Meir Medical Center, Kfar Saba 4428164, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Osnat","family":"Jarchowsky Dolberg","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine A, Meir Medical Center, 59 Tchernichovsky St, Kfar Saba 4428164, Israel"},{"name":"Gray School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel"},{"name":"Hematology Institute, Meir Medical Center, Kfar Saba 4428164, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/j.beem.2018.09.004","article-title":"Primary hyperparathyroidism","volume":"32","author":"Silva","year":"2024","journal-title":"Best Pract. 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