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Hypercalcemia is an uncommon but clinically significant complication of pediatric malignancies that often presents with symptoms. However, in this case series, we report 4 children with nonspecific symptoms of hypercalcemia detected incidentally on routine biochemical evaluation at the time of leukemia diagnosis.

Patients, 5 to 9 years of age, had underlying malignancies, including Hodgkin lymphoma (stage IIA), pre-B-cell acute lymphoblastic leukemia, and acute promyelocytic leukemia. All the patients presented with severe hypercalcemia, necessitating prompt intervention. Treatment consisted of hyperhydration, loop diuretics, bisphosphonates, and calcitonin, along with the management of the underlying malignancy. Successful resolution of hypercalcemia was achieved in all cases, with no future recurrence.

This case series highlights the importance of the routine biochemical screening for newly diagnosed pediatric malignancies, particularly for nonspecific symptoms of hypercalcemia, which may otherwise go unrecognized. Although hypercalcemia in hematological malignancies is well-documented, our findings stress the silent presentation and reinforce the clinical need for early identification to avoid metabolic complications.