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Hypercalcemia of Malignancy


Presentation

  • We present a case report of a severe hypercalcemia due to a rare association and review the relevant literature.[ncbi.nlm.nih.gov]
  • The poster will present the clinical case of a patient with hypercalcemia (serum corrected calcium 14.2 mg/dL) in the setting of progression of well differentiated metastatic neuroendocrine tumor who presented with dehydration, progressive muscle weakness[advancedpractitioner.com]
Fatigue
  • We report the case of a 63-year-old man who presented with weakness, fatigue, dehydration, confusion, abdominal pain, congestive heart failure and hypercalcemia.[ncbi.nlm.nih.gov]
  • Patients with mild hypercalcemia (serum calcium 10.5-12 mg/dL) can present with constipation, fatigue, and depression.[advancedpractitioner.com]
  • The most common ( 10%) symptoms at baseline were fatigue, anorexia, nausea, lethargy, and constipation.[academic.oup.com]
  • Most commonly reported adverse reactions are renal toxicity, flu-like symptoms, injection site reactions, hypocalcemia, hypophosphatemia, fatigue, muscle weakness, and constipation of diarrhea.[oatext.com]
  • Complicating diagnosis, the same symptoms common to advanced cancer are also seen in hypercalcemia of malignancy: nausea, constipation, anorexia, malaise and fatigue.[acphospitalist.org]
Fever
  • A 72-year-old Japanese man was admitted to our institution complaining of fever and abdominal pain. Abdominal computed tomography demonstrated a large tumor in the body of the pancreas, with multiple liver metastases.[ncbi.nlm.nih.gov]
  • […] during allantoin formation. 6 Rasburicase is approved at a dosage of 0.15 to 0.2 mg/kg IV once daily in 50 mL of normal saline infused over 30 minutes for 5 days; it does not require adjustment for decreased renal function. 6,29 Adverse effects include fever[uspharmacist.com]
  • […] abnormalities of cardiac conduction First-line medications: Intravenous Bisphosphonate Pamidronate Inhibit osteoclast activity; decrease bone resorption 60-90 mg IV over 2 hr in a solution of 50-200 ml of NS or D5W Nephrotoxicity, flu-like symptoms with fever[oatext.com]
Camping
  • Thus, the PTH-like activity for stimulating cAMP generation in the bone and kidney was attributed to PTH-rP.[ncbi.nlm.nih.gov]
  • At this time, nephrogenous cAMP remains the gold standard as a bio-assay until the PTHrP or other protein assays are able to achieve maximum clinical sensitivity and specificity.[aacc.org]
Ascitic Fluid
  • Increased levels of PTHrP were present both in the serum (4.9 pmol/l; normal for adults 1.5) and ascitic fluid (6.1 pmol/l).[ncbi.nlm.nih.gov]
Intravenous Administration
  • Intravenous administration can be cumbersome in patients admitted to long-term care settings or at home. We have developed and tested a new way of administering clodronate via subcutaneous infusion.[ncbi.nlm.nih.gov]
Nausea
  • However, mithramycin is not commonly recommended in hypercalcemia associated with malignancy due to dose-related adverse effects including nausea, vomiting, stomatitis, thrombocytopenia, and renal and hepatotoxicity.[oatext.com]
  • The most common ( 10%) symptoms at baseline were fatigue, anorexia, nausea, lethargy, and constipation.[academic.oup.com]
  • Typical symptoms include nausea, vomiting, constipation, abdominal pain, anorexia, weight loss, bone pain, polyuria, fatigue, and weakness.[cjasn.asnjournals.org]
  • They may include nausea, vomiting, lethargy, cardiac dysrhythmias, seizures, muscle cramps, and renal failure. 28,29 Although symptoms may occur before the start of ChT, they are more commonly observed within 12 to 72 hours after initiation of cytotoxic[uspharmacist.com]
  • The most common adverse reactions in patients receiving XGEVA for giant cell tumor of bone were arthralgia, headache, nausea, back pain, fatigue, and pain in extremity.[xgeva.com]
Vomiting
  • However, mithramycin is not commonly recommended in hypercalcemia associated with malignancy due to dose-related adverse effects including nausea, vomiting, stomatitis, thrombocytopenia, and renal and hepatotoxicity.[oatext.com]
  • Typical symptoms include nausea, vomiting, constipation, abdominal pain, anorexia, weight loss, bone pain, polyuria, fatigue, and weakness.[cjasn.asnjournals.org]
  • Symptoms include nausea, vomiting, abdominal pain, bone pain, fatigue, and confusion. Ultimately, HCM can result in renal failure, coma, and death, with an estimated 50% survival of 30 days regardless of treatment ( 4 ).[academic.oup.com]
  • They may include nausea, vomiting, lethargy, cardiac dysrhythmias, seizures, muscle cramps, and renal failure. 28,29 Although symptoms may occur before the start of ChT, they are more commonly observed within 12 to 72 hours after initiation of cytotoxic[uspharmacist.com]
  • This can be managed by: Treating the cancer Replacing fluids lost through vomiting, frequent urination, or other reasons Taking medicines to help stop the breakdown of bone.[cancer.net]
Abdominal Pain
  • We report the case of a 63-year-old man who presented with weakness, fatigue, dehydration, confusion, abdominal pain, congestive heart failure and hypercalcemia.[ncbi.nlm.nih.gov]
  • Complete Peer review History: Abstracts Hypercalcemia in malignancy can present with metabolic derangement, generalized weakness, altered mental status, renal compromise, cardiac dysrhythmias including atrial fibrillation and bradycardia, abdominal pain[sciencedomain.org]
  • Case A 63-year-old man with hypertension, diabetes, and recently diagnosed squamous-cell lung cancer presents with diffuse abdominal pain and confusion of two-day duration.[the-hospitalist.org]
  • People with hypercalcemia may have the following symptoms: Loss of appetite Nausea and vomiting Constipation and abdominal pain Increased thirst and frequent urination Fatigue, weakness, and muscle pain Confusion, disorientation, and difficulty thinking[cancer.net]
Loss of Appetite
  • People with hypercalcemia may have the following symptoms: Loss of appetite Nausea and vomiting Constipation and abdominal pain Increased thirst and frequent urination Fatigue, weakness, and muscle pain Confusion, disorientation, and difficulty thinking[cancer.net]
  • Symptoms of hypercalcemia include: nausea vomiting loss of appetite, or anorexia constipation fatigue muscle weakness increased thirst frequent and increased urination dark yellow urine little or no sweating abnormal heart rhythm weaker muscle reflexes[cancer.ca]
Night Sweats
  • A 71-year-old male complaining of generalized weakness and night sweats for the past 3 months was sent to the emergency department when routine laboratory tests revealed a corrected serum calcium concentration of 14.4 mg/dL.[ncbi.nlm.nih.gov]
Bone Pain
  • In addition to improving the morbidity of acute hypercalcemia, bisphosphonate therapy has been shown to reduce bone pain and pathological fractures in patients with bone metastases, and calcitonin also has a potent analgesic effect in these patients.[ncbi.nlm.nih.gov]
  • pain and weakness irregular heart beat difficulty thinking and speaking clearly It might also lead to coma and eventually death if not treated.[cancerresearchuk.org]
  • pain or bone fracture Report symptoms to your doctor or healthcare team as soon as possible.[cancer.ca]
  • Other symptoms include bone pain, arthritis, and osteoporosis. [2].[oatext.com]
Muscle Weakness
  • Those with moderate hypercalcemia (12 to 14 mg/d) can develop polydipsia, polyuria, clinical dehydration, muscle weakness, and changes in mental status. Those with severe hypercalcemia can develop severe form of these symptoms.[advancedpractitioner.com]
  • Most commonly reported adverse reactions are renal toxicity, flu-like symptoms, injection site reactions, hypocalcemia, hypophosphatemia, fatigue, muscle weakness, and constipation of diarrhea.[oatext.com]
  • Neuromuscular effects include impaired concentration, confusion, corneal calcification, fatigue, and muscle weakness. 8 Nausea, abdominal pain, anorexia, constipation, and, rarely, peptic ulcer disease or pancreatitis are among the gastrointestinal manifestations[aafp.org]
  • Symptoms of hypercalcemia include: nausea vomiting loss of appetite, or anorexia constipation fatigue muscle weakness increased thirst frequent and increased urination dark yellow urine little or no sweating abnormal heart rhythm weaker muscle reflexes[cancer.ca]
  • Abnormally high level of calcium in the blood; manifestations include fatigability, muscle weakness, depression, anorexia, nausea, and constipation. High level of calcium in the blood Higher than normal levels of calcium in the blood.[icd10data.com]
Polyuria
  • Those with moderate hypercalcemia (12 to 14 mg/d) can develop polydipsia, polyuria, clinical dehydration, muscle weakness, and changes in mental status. Those with severe hypercalcemia can develop severe form of these symptoms.[advancedpractitioner.com]
  • Since some tumor cells can resorb or destroy bone directly, hypercalcemia develops more rapidly and more aggressively than other causes of hypercalcemia, along with classic symptoms of dehydration, anorexia, nausea/vomiting, constipation, and polyuria[oatext.com]
  • Typical symptoms include nausea, vomiting, constipation, abdominal pain, anorexia, weight loss, bone pain, polyuria, fatigue, and weakness.[cjasn.asnjournals.org]
  • A comparison of plasma vasopressin measurements with a standard indirect test in the differential diagnosis of polyuria. N Engl J Med 1981; 305: 1539-46. ‎[books.google.ro]
  • The administration of both has been shown to cause a metabolic alkalosis and hypokalemia with polyuria.[karger.com]
Nocturia
  • The clinical manifestations of hypercalcemia include: Central nervous system effects include lethargy, impaired concentration, fatigue, and muscle weakness; Renal effects include dehydration, polyuria, nocturia, nephrolithiasis resulting from hypercalciuria[oatext.com]
Stupor
  • Further elevations can result in more severe symptoms, including weakness, difficulty concentrating, confusion, stupor, and coma. 18 HCM usually is rapidly progressive; therefore, the presence of rapidly rising calcium levels should signal the possibility[uspharmacist.com]
  • […] subperiosteal resorption, bone cysts) Gastrointestinal “abdominal moans” Nausea, vomiting Anorexia, weight loss Constipation Abdominal pain Pancreatitis Peptic ulcer disease Neuromuscular “psychic groans” Impaired concentration and memory Confusion, stupor[aafp.org]
Altered Mental Status
  • Complete Peer review History: Abstracts Hypercalcemia in malignancy can present with metabolic derangement, generalized weakness, altered mental status, renal compromise, cardiac dysrhythmias including atrial fibrillation and bradycardia, abdominal pain[sciencedomain.org]
  • Patients receiving gallium have reported nausea, vomiting, lethargy, altered mental status, and both diarrhea and constipation. Calcitonin Calcitonin is a peptide hormone secreted by the parafollicular C cells of the thyroid gland.[cjasn.asnjournals.org]
Asthenia
  • Adverse Reactions The most common adverse reactions in patients receiving XGEVA with bone metastasis from solid tumors were fatigue/asthenia, hypophosphatemia, and nausea. The most common serious adverse reaction was dyspnea.[xgeva.com]
Encephalopathy
  • For patients who have a poor prognosis and no viable treatment options, the most humane course may be no treatment at all since encephalopathy will cloud their consciousness.[ncbi.nlm.nih.gov]

Workup

  • A thorough workup ruled out bone metastasis and confirmed increased parathyroid-related protein, the hallmark of HHM. After regaining consciousness, the patient refused further therapy and subsequently died.[ncbi.nlm.nih.gov]
  • Further workup for the etiology of his hypercalcemia revealed an appropriately suppressed, intact PTH and normal 25 (OH) Vitamin D and 1,25 (OH)2 Vitamin D levels.[the-hospitalist.org]
  • Approximately 50% of calcium is bound to protein, primarily albumin, and the remaining 50% is ionized and is in physiologic active form. [5] Workup When calcium levels are reported as abnormal, the first step is to measure the albumin level.[emedicine.medscape.com]
  • After an extensive workup, the patient was found to have lymphoma, which was causing hypercalcemia and suppressing PTH. The authors also review the literature on hypercalcemia of malignancy.[jaoa.org]
  • The workup to elucidate the etiology of his hypercalcemia revealed his intact PTH level to be appropriately suppressed to 0.95 pmol/l (normal range: 1.06-6.9 pmol/l) and his PTH-related peptide level to be 27 ng/l (normal range: 14-27 ng/l). 25-hydroxy[karger.com]
Liver Biopsy
  • Computed tomography scan and liver biopsy revealed recurrent transitional-cell carcinoma with extensive liver metastasis. The patient returned approximately 1 week after discharge with a serum calcium level of 13.9 mg/dL.[ncbi.nlm.nih.gov]
Hepatocellular Carcinoma
  • Infrequently, PTHrP- mediat ed hyperca lcemia occurs in head and neck tumor s [41,42], renal cell carcinom a [43,44], bladder cancer [45], pancreatic carcinoma [46], hepatocellular carcinoma [47], carcinoid tumors [48] and melanoma [49].[scribd.com]

Treatment

  • Multiple treatment modalities exist for the treatment of hypercalcemia, each with a different mechanism of action.[ncbi.nlm.nih.gov]

Prognosis

  • CONCLUSIONS: The plasma PTH-rp levels may help to predict the calcium-lowering effect of bisphosphonate and give an indication of the prognosis in patients with HM.[ncbi.nlm.nih.gov]
  • The development of this malignancy complication often purports a poor prognosis. Thorough evaluation to establish the cause of hypercalcemia is essential because some patients may actually have undiagnosed primary hyperparathyroidism.[journals.lww.com]
  • In general, hypercalcemia of malignancy portends a poor prognosis, and there are three main mechanisms by which hypercalcemia can occur: 1.[renalfellow.blogspot.com]

Etiology

  • Abstract The etiology, pathophysiology, and diagnosis of hypercalcemia associated with malignant diseases are discussed.[ncbi.nlm.nih.gov]
  • More broadly, the poster will include an overview of the presentation, etiology, therapeutic options, and practical considerations in managing this important oncologic syndrome.[advancedpractitioner.com]

Epidemiology

  • Obstetrics and Gynecology, Columbia University, New York, USA. 2 b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, USA. 3 c New York Presbyterian Hospital, New York, USA. 4 d Department of Epidemiology[ncbi.nlm.nih.gov]
  • Summary Epidemiology Prevalence is unknown.[orpha.net]
  • Epidemiology and etiology The most common causes of hypercalcemia in the United States are primary hyperthyroidism and malignancy.[oatext.com]
  • Epidemiology Hypercalcaemia is an uncommon problem. Primary hyperparathyroidism is the most common cause. It affects mainly postmenopausal women [ 5 ]. The incidence rate in the UK is 30 per 100,000 [ 6 ].[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • Abstract The etiology, pathophysiology, and diagnosis of hypercalcemia associated with malignant diseases are discussed.[ncbi.nlm.nih.gov]

Prevention

  • Abstract Ibandronate is an experimental intravenous bisphosphonate under study for the prevention or treatment of osteoporosis and skeletal complications of bone metastases, as well as hypercalcemia of malignancy.[ncbi.nlm.nih.gov]
  • Pitfalls, prevention, and treatment of hyperuricemia during tumor lysis syndrome in the era of rasburicase (recombinant urate oxidase). Biologics. 2008;2:129-141. 13. Tufan A, Unal N, Koca E, et al.[uspharmacist.com]
  • Co-administration of oral calcium supplement of 500 mg and multiple vitamins containing 400 IU of vitamin D are recommended to prevent hypercalcemia [4-7].[oatext.com]

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