title: Critical hypercalcemia following discontinuation of denosumab therapy for metastatic giant cell tumor of bone.
abstract: We report a 14 year-old female with Giant Cell Tumor of Bone, successfully treated with denosumab, who developed critical hypercalcemia after completion of therapy. Five months after her last denosumab treatment, serum calcium rose to 16.5 mg/dL (normal 8.7-10.8 mg/dL), nearly double her prior level of 8.4 mg/dL while receiving denosumab. She required emergent intervention to treat her hypercalcemia, which was attributed to rebound osteoclast activity and osteopetrotic bone. Denosumab is widely used in adults and increasingly in pediatric oncology populations and our experience demonstrates the need for close monitoring for electrolyte derangements following discontinuation.
authors.affiliation: Department of Pediatrics, Division of Pediatric Hematology and Oncology, University of Minnesota Children's Hospital, Minneapolis, Minnesota.
authors.forename: Nathan
authors.initials: N
authors.lastname: Gossai
authors.forename: Megan V
authors.initials: MV
authors.lastname: Hilgers
authors.forename: Lynda E
authors.initials: LE
authors.lastname: Polgreen
authors.forename: Emily G
authors.initials: EG
authors.lastname: Greengard
mesh_terms: D000293:Adolescent; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000473:pathology; D000069448:Denosumab; D005260:Female; D018212:Giant Cell Tumor of Bone / Q000188:drug therapy*; D006801:Humans; D006934:Hypercalcemia / Q000139:chemically induced*; D009362:Neoplasm Metastasis; D053245:RANK Ligand / Q000037:antagonists & inhibitors*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D053245:RANK Ligand; D000069448:Denosumab
keywords: denosumab; giant cell tumor of bone; hypercalcemia