A Hospital Survey of Hypocalcemia and Hypophosphatemia in Malignancy

Abstract

We evaluated the incidence of hypo- versus hypercalcemia and hypo- versus hyperphosphatemia in a survey of 158 patients with malignancy; 55/158 had bone metastases. When serum calcium levels were corrected for albuminemia, the incidence of hypo- and hypercalcemia was respectively 10.8% and 10.1%. Hypophosphatemia was found in 29.7% patients, hyperphosphatemia in 2.5%. The incidence was slightly different in presence of bone metastases. Hypocalcemia and hypophosphatemia prevailed in osteoblastic metastases and hypercalcemia in osteolytic metastases. The incidence of hypocalcemia and hypophosphatemia in malignancy was therefore surprisingly high, even apart from the presence of bone metastases. Both hypo- and hypercalcemia were associated with elevated serum alkaline phosphatase levels. Moreover, a calcium-phosphorus product reduction was observed in osteoblastic metastases, suggesting a condition of secondary hyperparathyroidism.

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“…In contrast, cancer is not known to be linked to hypocalcaemia. Two studies that looked at the prevalence of hypocalcaemia in cancer patients and included patients over the age of 25 years had wildly divergent findings because of the different patient populations analysed; 1.6% of 7625 ambulatory oncology patients were hypocalcaemic in one study 54 , while the other found an incidence of 10.8% in hospitalised patients 55 . Riancho et al reported an incidence of 5-13% in patients with solid tumours and bone metastases 56 .…”

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“…In hospitalized cancer patients the reported incidence of hypocalcaemia is less than 11% [ 13 ]. The measurement of serum iCa is common in patients admitted to ICUs, at least half of which will have values outside the reference range during the ICU stay.…”