Chapter 37 • Hypercalcemia is a major metabolic complication associated with malignant disease. • Hypercalcemia occurs in approximately 10% of patients with cancer. • Hypercalcemia has a specific predilection for squamous carcinoma of the bronchus, carcinoma of the breast, and multiple myeloma. • Hypercalcemia is frequently recognized late and managed poorly. • Parathyroid hormone–related protein (PTHrP) produces hormonal and paracrine effects. • Factors released by, or in response to, metastases in bone (receptor activator of nuclear factor–κB ligand [RANKL], PTHrP, transforming growth factor-α, tumor necrosis factor, interleukin-1 [IL-1], IL-6, and others) cause paracrine effects. • The final common pathway is osteoclastic bone resorption. • It is aggravated by renal functional abnormalities or renal effects of PTHrP, or both. • Determination of the stage of disease and subsequent antineoplastic options provides a logical approach to management. • Patient symptomatology is more relevant than the absolute calcium level. • The total calcium concentration must be corrected for serum albumin concentration. • Close attention to volume status and renal function are mandatory. • Causes of hypercalcemia other than malignancy should be considered. • Antitumor therapy should be implemented for best long-term results. • Consideration should be given to active palliation in the face of advanced disease when antitumor options are exhausted. • Extracellular fluid volume should be expanded to induce a calciuresis.
Hypercalcemia
Summary of Key Points
Incidence
Etiology of Complication
Evaluation of the Patient
Treatment
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Hypercalcemia
