From the Guidelines
Hypercalcemia treatment involves hydration, bisphosphonates, and other therapies. The primary goal is to reduce serum calcium levels and alleviate symptoms.
Treatment Options
- Hydration: Oral or intravenous hydration with normal saline is essential to correct dehydration and promote calciuresis 1.
- Bisphosphonates: These are the primary treatment for hypercalcemia, with options including zoledronic acid, pamidronate, and clodronate 1. Zoledronic acid is often preferred, with a recommended initial dose of 4 mg 1.
- Denosumab: This human monoclonal antibody can be used to treat hypercalcemia refractory to bisphosphonate therapy, with a recommended dose and administration route of subcutaneous injection 1.
- Glucocorticoids: These can be used as an adjunctive therapy, particularly in cases of vitamin D-mediated hypercalcemia 1.
- Calcitonin: This hormone can help reduce serum calcium levels, but its use is often limited due to potential side effects 1.
Monitoring and Prevention
- Serum calcium monitoring: Regular monitoring of serum calcium levels is crucial to assess treatment efficacy and prevent hypocalcemia 1.
- Renal function monitoring: Patients with hypercalcemia should have their renal function monitored, as bisphosphonates can affect kidney function 1.
- Prevention of hypercalcemia: In patients with chronic kidney disease, prevention of hypercalcemia is essential to avoid cardiovascular complications and mortality 1.
From the Research
Treatment Options for Hypercalcemia
The treatment for hypercalcemia depends on the underlying cause and severity of the condition. The following are some of the treatment options:
- Hydration: The first step in treating hypercalcemia is to restore extracellular volume and correct electrolyte deficiencies, such as potassium and magnesium 2, 3, 4, 5, 6.
- Loop diuretics: May be required in individuals with renal insufficiency or heart failure to prevent fluid overload 4, 6.
- Bisphosphonates: Are considered the drugs of choice for long-term management of hypercalcemia, particularly in cases of malignancy-associated hypercalcemia (MAH) 2, 3, 4, 6.
- Calcitonin: Is preferable for short-term control of severe hypercalcemia 2, 3, 4, 6.
- Glucocorticoids: May be effective in hypercalcemia due to lymphoma or granulomatous diseases, such as sarcoidosis 2, 3, 4, 6.
- Denosumab: A fully humanized anti-RANKL antibody, may be used to suppress bone resorption in cases of MAH 4.
- Parathyroidectomy: May be considered in cases of primary hyperparathyroidism (PHPT) depending on age, serum calcium level, and kidney or skeletal involvement 2.
- Dialysis: Is generally reserved for those with severe hypercalcemia complicated with kidney failure 6.
Specific Treatment Approaches
The treatment approach may vary depending on the underlying cause of hypercalcemia:
- Primary hyperparathyroidism (PHPT): Treatment may involve parathyroidectomy or observation with monitoring 2.
- Malignancy-associated hypercalcemia (MAH): Treatment may involve bisphosphonates, calcitonin, or denosumab 2, 3, 4, 6.
- Hypercalcemia due to granulomatous diseases or lymphoma: Treatment may involve glucocorticoids 2, 3, 4, 6.