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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Adv+Pract+Oncol
2015 ; 6
(6
): 586-92
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Hypercalcemia of Malignancy
#MMPMID27648348
Malangone S
; Campen CJ
J Adv Pract Oncol
2015[Nov]; 6
(6
): 586-92
PMID27648348
show ga
A 60-year-old man initially presented with pain in the right upper quadrant in
October 2010. A computed tomography (CT) scan of the abdomen pelvis completed at
that time showed a mass at the junction of the body and tail of the pancreas and
multiple large liver lesions. A CT-guided liver biopsy revealed low-grade
neuroendocrine carcinoma. The patient was initially started on systemic treatment
with sunitinib (Sutent) and octreotide. He developed intolerable side effects,
including nausea and migraine. Therapy was discontinued in October 2011, when a
CT scan revealed evidence of disease progression. At this point, he was
transitioned to everolimus (Afinitor). He was treated with everolimus, with
overall stable disease, until a magnetic resonance image (MRI) of the abdomen and
pelvis showed enlarging hepatic metastases in April 2014. Everolimus was
discontinued. The patient presented to the clinic to start third-line systemic
therapy; he described the recent onset of disorientation at home, with difficulty
in concentration and mild muscle weakness. He was found to be lethargic on the
day of the visit. He was noted to have a 4-kg weight loss. Blood pressure was
82/45 mm Hg, with a heart rate of 115 beats/minute. Lab tests revealed a serum
calcium level of 12.7 mg/dL (9.5 mg/dL prior). At that time, the serum albumin
level was 2.4 mg/dL. The corrected calcium for albumin was 14 mg/dL. The patient
was treated with intravenous (IV) hydration, and vital signs normalized post
treatment. Labs revealed an improvement in serum calcium to 11.8 mg/dL (corrected
= 13.1 mg/dL). Additional laboratory analysis revealed vitamin D, 25-hydroxy
level of 40 ng/mL (reference range, 20-50 ng/mL), parathyroid hormone-related
protein of 5.2 pmol/L (reference range, < 2.0 pmol/L), thyroid-stimulating
hormone of 1.04 mIU/mL (reference range, 0.35-4.00 mIU/mL). An electrocardiogram
revealed sinus tachycardia with a QT of 31.6 ms (QTc of 38.4 ms). The patient
improved symptomatically and was sent home. The patient returned for repeat labs
1 week later, with worsening of previously described weakness and lethargy. The
serum calcium level had increased to 13.2 mg/dL, with a serum albumin level of
2.8 mg/dL. Intravenous zoledronic acid (4 mg) was administered, and he was
admitted for symptomatic hypercalcemia. He received continuous IV hydration with
normal saline at 300 mL/hr and telemetry monitoring. Once hydrated, he was
treated with IV furosemide. His serum calcium level rapidly improved to 10 mg/dL
by day 2 of admission, and lethargy and weakness symptoms resolved. He was
discharged from the hospital at that time. After discharge, the patient continued
on third-line capecitabine-based systemic therapy, with excellent radiologic and
tumor marker response to therapy and monthly zoledronic acid infusion. Serum
calcium levels returned to within the normal range and stable, and he remained
without relapse of hypercalcemia. After 2 months, zoledronic acid was
discontinued, and the serum corrected calcium remained within normal limits.
free
free
free
