From the Guidelines
Hypercalcemia is a dangerous condition that can lead to serious health complications, including organ damage and death, if left untreated, with a median survival of about 1 month after discovery in patients with lung cancer 1.
Causes and Symptoms of Hypercalcemia
The condition can be caused by various factors, including hyperparathyroidism, certain cancers, medications, excessive vitamin D, or prolonged immobility. Symptoms of hypercalcemia depend on the severity and acuity of onset, ranging from mild symptoms such as polyuria, polydipsia, nausea, and confusion, to severe symptoms like mental status changes, bradycardia, and hypotension 1.
Treatment of Hypercalcemia
Treatment of hypercalcemia depends on the severity and cause of the condition. For mild cases, oral hydration may be effective, while moderate to severe cases require rehydration with IV crystalloid fluids and loop diuretics, as well as bisphosphonates such as zoledronic acid or pamidronate 1. Bisphosphonates, such as zoledronic acid, have been shown to efficiently control hypercalcemia, with a normalization of calcium levels in 50% of patients 1.
Prognosis and Quality of Life
Hypercalcemia is an independent negative prognostic factor for survival in cancer patients, and its presence can significantly impact the quality of life, leading to symptoms such as fatigue, weakness, and cognitive issues 1. Therefore, prompt diagnosis and treatment of hypercalcemia are crucial to prevent long-term complications and improve patient outcomes, with a focus on managing symptoms and improving quality of life 1.
From the FDA Drug Label
Excessive release of calcium into the blood as bone is resorbed results in polyuria and gastrointestinal disturbances, with progressive dehydration and decreasing glomerular filtration rate This, in turn, results in increased renal resorption of calcium, setting up a cycle of worsening systemic hypercalcemia.
Hypercalcemia is dangerous because it can lead to:
- Polyuria
- Gastrointestinal disturbances
- Progressive dehydration
- Decreasing glomerular filtration rate These effects can create a cycle of worsening systemic hypercalcemia. 2
From the Research
Definition and Prevalence of Hypercalcemia
- Hypercalcemia is a condition characterized by elevated calcium levels in the blood, affecting approximately 1% of the worldwide population 3.
- It can be mild, moderate, or severe, with severe hypercalcemia being a life-threatening condition that requires immediate medical attention 4, 5.
Causes of Hypercalcemia
- Primary hyperparathyroidism (PHPT) and malignancy are the most common causes of hypercalcemia, accounting for more than 90% of all cases 3, 6.
- Other causes include granulomatous diseases, endocrinopathies, immobilization, genetic disorders, and certain medications or supplements 3.
- Hypercalcemia can also occur after discontinuation of denosumab, a medication used to treat giant cell tumor of bone 7.
Symptoms and Complications of Hypercalcemia
- Mild hypercalcemia is often asymptomatic, but can cause constitutional symptoms such as fatigue and constipation in approximately 20% of people 3.
- Severe hypercalcemia can cause nausea, vomiting, dehydration, confusion, somnolence, and coma, and is associated with a high mortality rate if left untreated 4, 5.
- Hypercalcemia can also lead to kidney damage, metabolic acidosis, and osteitis fibrosa cystica, a condition characterized by bone softening and deformities 6.
Diagnosis and Treatment of Hypercalcemia
- Serum intact parathyroid hormone (PTH) is the most important initial test to evaluate hypercalcemia, and can help distinguish between PHPT and other causes of hypercalcemia 3.
- Treatment of hypercalcemia depends on the underlying cause and severity of the condition, and may include hydration, intravenous bisphosphonates, glucocorticoids, and dialysis 3, 6, 4, 5.
- Oral bisphosphonates can be effective in managing refractory severe hypercalcemia, especially in cases where denosumab has been discontinued 7.