Medical treatment of hypercalcaemia

Makras, Polyzois; Papapoulos, Socrates E.

doi:10.14310/horm.2002.1225

Cited by 41 publications

(41 citation statements)

References 56 publications

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“…Interestingly, serum PTHrP was also elevated and detected immunohistochemically in the tumour specimen (VanHouten et al 2006). Although successful treatment of the underlying neoplasm usually suffices to control the clinical symptoms and systemic sequelae of hypercalcaemia, in cases of severe, residual or recurrent disease, medical treatment of hypercalcaemia is also required (Makras & Papapoulos 2009). …”

Section: Hypercalcaemiamentioning

confidence: 99%

Paraneoplastic syndromes secondary to neuroendocrine tumours

Kaltsas

Androulakis²,

Herder³

et al. 2010

Endocrine-Related Cancer

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Neuroendocrine tumours may be either benign or malignant tumours, and have the ability to synthesise and secrete biologically active substances characteristic of the cell of origin that can cause distinct clinical syndromes. The term 'paraneoplastic syndromes' (PNSs) is used to denote syndromes secondary to substances secreted from tumours not related to their specific organ or tissue of origin and/or production of autoantibodies against tumour cells; such syndromes are mainly associated with hormonal and neurological symptoms. Appreciation of the presence of such syndromes is important as clinical presentation, if not identified, may delay the diagnosis of the underlying neoplasia. Conversely, early recognition can allow for more rapid diagnosis, particularly as the coexistence of a neoplasm with a clinical or biochemical marker offers an additional determinant of tumour status/progression. PNSs can complicate the patient's clinical course, response to treatment, impact prognosis and even be confused as metastatic spread. Their diagnosis involves a multidisciplinary approach, and detailed endocrinological, neurological, radiological and histological studies are required. Correct diagnosis is essential as the treatment of choice will be different for each disorder, particularly in the case of malignant tumours; it is therefore important to develop appropriate means to correctly identify and localise these tumours. Clinical awareness and the incorporation into clinical practise of 111 In-octreotide scintigraphy, chromogranin A and other evolving biochemical marker measurement techniques have substantially contributed to the identification of patients harbouring such syndromes. Diseasespecific medical therapies are mandatory in order to prevent recurrence and/or further tumour growth. Owing to their rarity, central registration of these syndromes is very helpful in order to be able to provide evidence-based diagnostic and therapeutic approaches.

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Section: Hypercalcaemiamentioning

confidence: 99%

Paraneoplastic syndromes secondary to neuroendocrine tumours

Kaltsas

Androulakis²,

Herder³

et al. 2010

Endocrine-Related Cancer

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“…Medical therapy is, therefore, aimed at inhibiting bone resorption and promoting renal calcium excretion. 1,11 Evidence-based therapies for management include intravenous crystalloid fluids with or without loop diuretics, bisphosphonates, calcitonin, The important general supportive measures include the removal of calcium from parenteral feeding solutions (a measure often overlooked); the discontinuation of oral calcium supplement in enteral feeding solutions or in the form of calcium tablets; the discontinuation of medications that may independently lead to hypercalcemia (e.g., lithium, calcitriol, vitamin D and thiazides); an increase in the weight-bearing mobility of the patient, if possible; and the discontinuation of the use of sedative drugs, including analgesic drugs if possible to enhance the patient's mental clarity and promote wight-bearing ambulation. 5 Many hypercalcemia patients are presented with dehydration due to renal water concentrating defects (nephrogenic diabetes insipidus) and decreased oral hydration resulting from anorexia and nausea, vomiting, or both.…”

Section: 12mentioning

confidence: 99%

“…5,11 This first step of therapy serves to rehydrate the patient while enhancing calciuresis by increasing the glomerular filtration rate and reducing the fractional reabsorption of calcium and sodium. 1,11 Although there are no randomized clinical trial to guide this therapy, in general practice normal saline is administered at a rate of 200-500 mL per hour, depending on the baseline level of dehydration and renal function, the patient's cardiovascular status, the degree of renal impairment, and the severity of the hypercalcemia. These factors must be assessed with the use of careful clinical monitoring for physical finding that are consistent with fluid overload.…”

Section: 12mentioning

confidence: 99%

“…Progression of HCM can be prevented with apropriate measures, including hydration, anticancer therapy, and treatment with bisphosphonates. 7,11,12 Hypercalcemia is, in almost all patients, due to an elevation in the physiologically important ionized (or free) calcium concentration. However, 40-45% of the calcium in serum is bound to protein, principally albumin.…”

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confidence: 99%

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Hypercalcemia of Malignancy: Clinical Characteristics and Treatment Outcome

Wijaya¹,

Oehadian²,

Sumantri³

2014

mkb

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Hypercalcemia is one of the most common paraneoplastic syndromes in hospitalized malignancy patients. The aim of this study was to determine the clinical characteristics and treatment outcome in hypercalcemia of malignancy. This was a study using medical records of patients with malignancy hospitalized in the Departement of Internal Medicine, Dr. Hasan Sadikin Hospital Bandung between December 2008 and March 2011. Statistical analysis was performed by Wilcoxon and Mann-Whitney tests. There were 40 patients with hypercalcemia of malignancy, consisted of 22 hematologic malignancies and 18 solid tumors. Disturbance of consiousness were found in 4, dehydration in 18, constipation in 6, and nausea and vomiting in 6 subjects. In 16 subjects, no symptoms were found. All subjects received rehydration with normal saline. Bisphosphonate was given in 26 subjects. The difference of decreasing ion calcium level, between the groups who were treated with or without bisphosphonate was 0.59 (0.01-1.17) mg/dL, p=0.0001. Dari 40 penderita dengan hiperkalsemia pada keganasan, didapatkan 22 keganasan hematologi dan 18 tumor padat. Gejala klinis yang ditemukan adalah gangguan kesadaran pada 4 subjek, dehidrasi pada 18 subjek, konstipasi pada 6 subjek, mual dan muntah pada 6 subjek. Pada 16 subjek tidak ditemukan gejala. Semua subjek mendapatkan rehidrasi dengan NaCl 0,9%. Dua puluh enam subjek mendapat terapi bisfosfonat. Perbedaan penurunan kadar kalsium ion antara kelompok yang mendapatkan bisfosfonat dan tidak adalah 0,59 (0,01-1,17) mg/dL, p=0,0001. Simpulan, proporsi keganasan penyebab hiperkalsemia hampir sama antara keganasan hematologi dan tumor padat. Terapi rehidrasi dengan NaCl 0,9% tanpa atau disertai bisfosfonat memberikan hasil yang baik. [MKB. 2014;46(2):111-17]

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“…The hypercalcemias (HCa) are a common and heterogeneous group of disorders, ranging from the occasional detection of a high level of serum calcium during routine laboratory assessment to a life-treating condition [1][2][3][4][5] . In general, the signs and symptoms are not specific, and are related to the level of serum calcium, to the rate of calcium increase and to the underlying condition producing HCa.…”

Section: Introductionmentioning

confidence: 99%

Challenges in the differential diagnosis of hypercalcemia: A case of hypercalcemia with normal PTH level

Pellicciotti

Giusti²,

Gelli³

et al. 2012

WJCO

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The hypercalcemias are a common and heterogeneous group of disorders, ranging from the occasional detection of a high level of serum calcium to a life-treating condition. In a patient presenting with hypercalcemia, a differential diagnosis can be established easily by measuring serum calcium and parathyroid hormone (PTH) concentrations. We describe the case of an 83-year-old man presenting with a severe symptomatic hypercalcemia with high-normal PTH level due to the coexistence of primary hyperparathyroidism and malignancy-associated hypercalcemia. The presence of two conditions producing hypercalcemia was revealed only during inhospital stay and after the administration of an intravenous bisphosphonate, when the PTH concentration increased rapidly after bisphosphonate treatment with a decrease in serum calcium. The occurrence of two conditions producing hypercalcemia is a rare event in the literature, and should be considered in the presence of an abnormally high serum calcium level associated with normal or high-normal PTH, in order to establish a correct diagnosis and appropriate interventions.

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Medical treatment of hypercalcaemia

Cited by 41 publications

References 56 publications

Paraneoplastic syndromes secondary to neuroendocrine tumours

Paraneoplastic syndromes secondary to neuroendocrine tumours

Hypercalcemia of Malignancy: Clinical Characteristics and Treatment Outcome

Challenges in the differential diagnosis of hypercalcemia: A case of hypercalcemia with normal PTH level

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