I book a test of calcium my doctor mention this on my reports please help me to understand this:- increased in primary and tertiary hyperparathyroidism, malignant disease with bone involvement, polycythemia vera, pheochromocytoma and sarcoidosis. Advise: pth testing. If normal or increased, then check urine ca++/ creatinine ratio to exclude familial benign hypocalciuric hypercalcemia (fbhh) decreased in surgical or congenital hyperparathyroidism vitamin d deficiency, chronic renal failure magnesium deficiency, prolonged anticonvulsant therapy, acute pancreatitis, hyperphosphatemia, massive blood transfusion, leprosy, proximal and distal renal tubular disease, alcoholism and hepatic cirrhosis. Advice: albumin, phosphate, creatinine, alkaline phosphatase and pth.