title: Tumour induced hypercalcaemia: a case for active treatment.
abstract: This paper reports a retrospective survey of the diagnosis, management and outcome of hypercalcaemia in patients admitted to a regional oncology centre over a 12-month period; 168 cases of tumour induced hypercalcaemia were identified. In 69 patients (41%) the presence of hypercalcaemia was not noted in the case records; in a further 15 patients (9%) a positive decision was made not to treat the condition, although some of these patients continued to receive other forms of active treatment. Of the remaining patients, 20 (12%) received intravenous fluids alone and 64 (38%) received bisphosphonate therapy. Of those patients with initial serum calcium > 3 mmol/l 71% were treated with bisphosphonates. Median survival from onset of hypercalcaemia was only 2 months, but in the bisphosphonate treated group, 98% experienced a fall in serum calcium within a week of treatment. We believe that the symptomatic relief associated with a fall in serum calcium justifies active management even in the face of a poor prognosis. A large proportion of cases of tumour induced hypercalcaemia remain undiagnosed or untreated and we believe that this deserves further attention.
authors.affiliation: Department of Human Metabolism and Clinical Biochemistry, University of Sheffield, UK.
authors.forename: N P
authors.initials: NP
authors.lastname: O'Rourke
authors.forename: E V
authors.initials: EV
authors.lastname: McCloskey
authors.forename: J A
authors.initials: JA
authors.lastname: Kanis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood; D004164:Diphosphonates / Q000627:therapeutic use; D005260:Female; D005440:Fluid Therapy; D005500:Follow-Up Studies; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy; D015995:Prevalence; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D004164:Diphosphonates; D002118:Calcium