Symptomatic

• Fractures (especially vertebral compression fractures).
  
• Nephrolithiasis.
  
• Severe neuromuscular weakness.
  
• Easy fatigability.
  
• Loss of stamina.
  
• Sleep disturbance.
  
• Depression.
  
• Memory loss.
  
• Pancreatitis.
  
• History of an episode of life-threatening hypercalcemia.
  
• Carcinoma.

Asymptomatic

• Markedly elevated serum calcium (> 1.0 mg/dL above normal).
  
• Markedly elevated 24-hour urinary calcium excretion (> 400 mg).
  
• Abnormal serum creatinine.
  
• Reduced bone mineral density (T-score < −2.5).
  
• Age younger than 50 years.
  
• Carcinoma.

• Pregnancy (first trimester).
  
• Multiple comorbidities precluding safe intervention.
  
• Idiopathic hypercalcemia.