Severe prolonged hypocalcaemia following pamidronate for malignant hypercalcaemia.
Hypercalcaemia of malignancy is a frequent occurrence. First line treatment of this condition involves the use of bisphosphonates. This report sets out the clinical findings in a patient presenting with metastatic breast cancer and hypercalcaemia (corrected serum calcium 3.72 mmol/l) who had received previous surgery for a parathyroid adenoma. After treatment with pamidronate, profound, prolonged (more than 60 days) symptomatic hypocalcaemia was observed. We discuss the possible explanations for these observations and conclude that a normal parathyroid reserve is probably necessary for the smooth normalization of blood calcium when bisphosphonates are used to treat malignant hypercalcaemia.
Sims
E C
EC
St Bartholomew's Hospital, London, UK.
Rogers
P B
PB
Besser
G M
GM
Plowman
P N
PN
D000230:Adenocarcinoma / Q000150:complications / Q000188:drug therapy* / Q000556:secondary; D000236:Adenoma / Q000601:surgery; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000556:secondary; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy*; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000188:drug therapy* / Q000209:etiology; D006996:Hypocalcemia / Q000139:chemically induced*; D000077268:Pamidronate; D010257:Paraneoplastic Syndromes / Q000188:drug therapy* / Q000209:etiology; D010282:Parathyroid Neoplasms / Q000601:surgery; D016105:Parathyroidectomy
D000970:Antineoplastic Agents; D004164:Diphosphonates; D000077268:Pamidronate