Emergency Management of Malignancy-Associated Hypercalcemia

Abstract

The most common cause of hypercalcemia in the emergency department (ED) is malignancy-associated hypercalcemia (MAH), which can be caused by direct bone resorption from bone metastases, vitamin D secreting malignancies, and increased parathyroid hormone (PTH) or PTH-related protein (PTHrP) levels. Malignancy-associated hypercalcemia is associated with a very poor prognosis, with half of the patients dying within a month of diagnosis. Management consists of adequate hydration, bisphosphonate therapy, and correction of other abnormal electrolyte levels. Currently, no therapies have demonstrated an effect on mortality and are therefore viewed only as a means of stabilizing the patient until the underlying condition can be treated. All MAH patients should receive an oncology consult as soon as possible so they are able to receive treatment for the causative malignancy and increase their chance of survival.

No Stones, Some Groans, and Psychiatric Overtones with “Non-specific” Splenomegaly

“…Hypercalcemia can be stratified into mild (10-12 mg/dL), moderate (12-14 mg/dL), and severe (> 14 mg/dL). Severe hypercalcemia requires aggressive treatment with intravenous fluids (IVF), furosemide diuresis, calcitonin, and bisphosphonates [1]. Common causes include hyperparathyroidism, supplement or medication use, and/or malignancy [2].…”

“…Hypercalcemia is a potentially life-threatening electrolyte imbalance that is commonly caused by hyperparathyroidism, supplement or medication use, and/or malignancy [1-2]. Splenomegaly is commonly a non-specific finding, but in the setting of hypercalcemia, may provide diagnostic insight into the underlying pathology and warrant further evaluation.…”

Diagnosis, Pathophysiology and Management of Hypercalcemia in Malignancy: A Review of the Literature

“…Among all patients who present to the emergency department with hypercalcemia, the most common causes are malignancy followed by primary hyperparathyroidism [2,5]. The incidence of hypercalcemia at the early pre-sentation of cancer is low (1-5 %) but increases in advanced stage cancer [6] associated with poor prognosis [7] with a median duration of survival, for these patients, of 2-6 months from disease onset [7]. Among all cancers, multiple myeloma has the highest prevalence of hypercalcemia [7,8] followed by breast, renal, and squamous carcinomas of any origin [1,2,9,10].…”

“…The incidence of hypercalcemia at the early pre-sentation of cancer is low (1-5 %) but increases in advanced stage cancer [6] associated with poor prognosis [7] with a median duration of survival, for these patients, of 2-6 months from disease onset [7]. Among all cancers, multiple myeloma has the highest prevalence of hypercalcemia [7,8] followed by breast, renal, and squamous carcinomas of any origin [1,2,9,10]. Of the total liquid malignancies, multiple myeloma is the most prevalent hematological cancer associated with hypercalcemia, followed by leukemia and non-Hodgkin lymphoma [1,2,7,[11][12][13].…”

Kasabach‑Merritt syndrome combined with hypercalcemia: A case report

“…Clinical manifestations of HC vary greatly from asymptomatic phenotypes to hypercalcemic crisis, and the latter is life-threatening (13,15). As the calcium balance is the combined effect of regulation through parathyroid hormone (PTH), calcitonin and active vitamin D3 [1,25-(OH)2D3] upon various organs, including intestine, kidney and bones, abnormalities in any segments of this regulatory process may lead to calcium metabolic disturbance (16).…”