Background: Hypercalcemia and associated primary hyperparathyroidism (pHPT) are relatively common but are likely to be under-recognized and undertreated. This study aimed to assess the prevalence of incidental hypercalcemia, investigation, and follow-up with definitive care for an acute surgical Australian metropolitan population. This was complemented by a systematic review of the literature. Materials and methods: A retrospective cohort study was conducted in a metropolitan, 172-bed general hospital within the Metro South Health service district of South-East Queensland, Australia. The electronic medical records of all acute general surgical admissions over a 6-month period (February–July 2019 inclusive) were reviewed and analyzed. This was supplemented by a systematic literature review of incidental hypercalcemia and hyperparathyroidism. Results: Of 486, eligible patients requiring acute surgical admission, two were identified to possess incidental hypercalcemia, equating to an incidence of 0.41%. Within this context, the systematic review revealed a reported hypercalcemia prevalence of between 0.1 and 3.3% and a pHPT prevalence of between 1.3 and 3.5%. The incidence of new pHPT was between 6 and 50 per 1,00,000. Discussion: This study is the first to investigate the incidence of incidental hypercalcemia and related hyperparathyroidism in an acute general surgical admission setting. Whilst the outcomes of this study have not shown expectedly high rates of hypercalcemia and hyperparathyroidism, this provides a platform for future clinical education, awareness, local protocol development, and improved patient care. Clinical significance: The first study to investigate the incidence of incidental hypercalcemia and hyperparathyroidism in an acute general surgical admission setting. Lower than expected rates of hypercalcemia and hyperparathyroidism (2 out of 486 eligible patients) based on literature review which sets the platform for future research directions.