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Over a period of six months all reports in the South Tees Health District of serum calcium levels greater than 2.70 mmol/l were extracted and patient records examined to establish the associated diseases and patterns of management. A total of 235 reports were evaluated, and after exclusion of doubtful cases 196 patients were included in the study. No cause had been identified in 57 (29%). Many of these were elderly females in whom hypercalcaemia may have been due to primary hyperparathyroidism, but parathyroid hormone levels had not been measured. Of those in whom a diagnosis had been made, 62 (45%) were associated with malignancy and 50 (36%) with chronic renal failure. 72% of cases of hypercalcaemia reported to general practitioners and 13% of those reported to hospital doctors were not investigated further. Despite the inclusion of serum calcium estimation on routine biochemical profiles, many cases of hypercalcaemia are being ignored or not investigated further. The study emphasizes the need for a reliable screening test for primary hyperparathyroidism.