Hypercalcemia Management

Today we discussed management of hypercalcemia of malignacy. Below is a useful table adopted from UpToDate and Sternlicht H, Glezerman IG. Hypercalcemia of malignancy and new treatment options. Ther Clin Risk Manag. 2015;11:1779–1788.

Dr. Kaitlin Brooke's Key Learning Points:

  • The majority of hypercalcemia of malignancy is PTHrP related, 20% is the result of bony metastasis with 1,25 dihydroxy Vitamin D and less than 1% are related to ectopic PTH production
  • Denosumab is effective for hypercalcemia of malignancy and not contraindicated in AKI or CKD, but can cause dangerous hypocalcemia in patients with impaired renal function
  • It is likely safe to treat patients with hypercalcemia of malignancy and sCr less than 4.5 with zoledronic acid
  • Patients with advanced underlying kidney disease and refractory severe hypercalcemia should be considered for hemodialysis
  • Hypercalcemia of malignancy indicates a poor prognosis on the order of months