title: Approach to diagnosis and treatment of hypercalcemia in a patient with malignancy.
abstract: Hypercalcemia is a common complication of malignancy and portends a worse prognosis. It causes a variety of symptoms in patients, which can range from confusion and polyuria to coma and death. There are 4 broad mechanistic categories to classify hypercalcemia of malignancy: local osteolysis secondary to metastatic cancer or multiple myeloma, excess parathyroid-related hormone, excess 1,25-dihydroxyvitamin D production, and ectopic parathyroid hormone production. Volume expansion with normal saline solution and treatment with intravenous bisphosphonates to decrease osteoclast-mediated bone destruction are effective initial therapies. Calcitonin, gallium nitrate, and corticosteroids can serve as adjunctive therapies. Denosumab is an attractive therapeutic option for refractory cases of hypercalcemia, although more data are required before this therapy can be recommended.
authors.affiliation: Department of Medicine, University of Virginia Health System, Charlottesville, VA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Reagan
authors.affiliation: Division of Nephrology and Dialysis, Azienda Ospedaliera "G. Brotzu," Cagliari, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Pani
authors.affiliation: Department of Medicine, University of Virginia Health System, Charlottesville, VA. Electronic address: mhr9r@virginia.edu.
authors.forename: Mitchell H
authors.initials: MH
authors.lastname: Rosner
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D001842:Bone and Bones / Q000378:metabolism; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000473:pathology / Q000601:surgery; D004164:Diphosphonates / Q000008:administration & dosage*; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D007668:Kidney / Q000378:metabolism; D008297:Male; D009061:Mouth Mucosa / Q000473:pathology; D009062:Mouth Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D009364:Neoplasm Recurrence, Local; D000077268:Pamidronate; D044162:Parathyroid Hormone-Related Protein / Q000097:blood; D015532:Rehydration Solutions / Q000008:administration & dosage; D012965:Sodium Chloride / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D044162:Parathyroid Hormone-Related Protein; D015532:Rehydration Solutions; D012965:Sodium Chloride; D000077268:Pamidronate
keywords: Hypercalcemia; bisphosphonate; cancer; parathyroid hormone–related protein