Palliative treatment of uncontrollable hypercalcemia due to parathyrotoxicosis:
denosumab as rescue therapy
#MMPMID26605043
Jumpertz von Schwartzenberg R
; Elbelt U
; Ventz M
; Mai K
; Kienitz T
; Maurer L
; Rose T
; Rückert JC
; Strasburger CJ
; Spranger J
Endocrinol Diabetes Metab Case Rep
2015[]; 2015
(?): 150082
PMID26605043
show ga
Parathyroid carcinoma is a rare disease leading to severe hypercalcemia due to
hyperparathyroidism. Surgery is the primary treatment option. A more progressive
form of the disease is characterized by parathyrotoxicosis, and subsequent
hypercalcemia is the most common cause of death. We report a case presenting with
severe hypercalcemia due to parathyrotoxicosis from parathyroid carcinoma treated
for the first time using the monoclonal antibody denosumab as a rescue therapy
and present long-term follow-up data. The 71-year-old patient presented with
severe hypercalcemia due to metastatic parathyroid carcinoma. Despite undergoing
treatment with bisphosphonates, cinacalcet hydrochloride, and forced diuresis,
the patient`s condition deteriorated rapidly due to resistant hypercalcemia.
Surgery performed because of spinal metastasis and forced diuresis lowered
calcium levels, albeit they remained in the hypercalcemic range and significantly
increased when forced diuresis was stopped. Considering a palliative situation to
overcome hypercalcemia, we decided to administer denosumab, a monoclonal antibody
that binds to the receptor activator of nuclear factor-kappa B ligand. After a
single subcutaneous administration of 60?mg denosumab, calcium levels normalized
within one day. Subsequent denosumab injections led to permanent control of serum
calcium for more than 2 years despite rising parathyroid hormone levels and
repeated surgeries. Together with recent cases in the literature supporting our
observation, we believe that denosumab is relevant for future trials and
represents an effective tool to control hypercalcemia in patients with advanced
stages of parathyroid cancer. LEARNING POINTS: Severe hypercalcemia is the most
common cause of death in patients with parathyroid carcinoma.The monoclonal
antibody denosumab rapidly lowered severely elevated serum calcium levels due to
parathyrotoxicosis.Denosumab was effective in the long-term treatment of
hypercalcemia despite progression of parathyroid carcinoma.
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