Hypercalcemia of malignancy
Hypercalcemia of Malignancy
Hypercalcemia of malignancy is a condition characterized by elevated levels of calcium in the blood, which is often associated with cancer. It is a common paraneoplastic syndrome and can occur in various types of malignancies.
Pathophysiology[edit | edit source]
Hypercalcemia of malignancy can occur through several mechanisms:
- Humoral Hypercalcemia of Malignancy (HHM): This is the most common mechanism and is caused by the secretion of parathyroid hormone-related peptide (PTHrP) by the tumor. PTHrP mimics the action of parathyroid hormone (PTH), leading to increased bone resorption and renal tubular reabsorption of calcium.
- Osteolytic Metastases: Certain cancers, such as breast cancer and multiple myeloma, can metastasize to bone, causing local osteolysis and release of calcium into the bloodstream.
- Vitamin D Secretion: Some lymphomas can produce active vitamin D (calcitriol), leading to increased intestinal absorption of calcium.
Clinical Presentation[edit | edit source]
Patients with hypercalcemia of malignancy may present with a variety of symptoms, which can be remembered by the mnemonic "stones, bones, groans, and psychiatric overtones":
- Renal: Nephrolithiasis (kidney stones), polyuria, and dehydration.
- Skeletal: Bone pain and fractures.
- Gastrointestinal: Nausea, vomiting, constipation, and abdominal pain.
- Neurological: Confusion, lethargy, and in severe cases, coma.
Diagnosis[edit | edit source]
The diagnosis of hypercalcemia of malignancy involves:
- Serum Calcium Levels: Elevated total and ionized calcium levels.
- Parathyroid Hormone (PTH) Levels: Typically low or suppressed in hypercalcemia of malignancy.
- PTHrP Levels: Elevated in cases of humoral hypercalcemia of malignancy.
- Bone Scans and Imaging: To identify osteolytic lesions or metastases.
Treatment[edit | edit source]
The management of hypercalcemia of malignancy includes:
- Hydration: Intravenous fluids to promote renal excretion of calcium.
- Bisphosphonates: Such as zoledronic acid or pamidronate, to inhibit bone resorption.
- Calcitonin: Provides a rapid but short-term reduction in calcium levels.
- Denosumab: A monoclonal antibody that inhibits RANKL, used in cases refractory to bisphosphonates.
- Glucocorticoids: Particularly effective in cases of vitamin D-mediated hypercalcemia.
- Dialysis: In severe cases where other treatments are ineffective.
Prognosis[edit | edit source]
The prognosis of hypercalcemia of malignancy is generally poor, as it often indicates advanced disease. The condition requires prompt treatment to prevent complications and improve quality of life.
See Also[edit | edit source]
External Links[edit | edit source]
- [American Cancer Society](https://www.cancer.org/)
- [National Cancer Institute](https://www.cancer.gov/)
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Contributors: Prab R. Tumpati, MD
