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Hypercalcemia of malignancy

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of hypercalcemia of malignancy are prepared by our editorial team based on guidelines from the Endocrine Society (ES 2022). ...
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Diagnostic investigations

Assessment of renal function: as per ES 2022 guidelines, assess renal function (CrCl or EGFR) before administering IV bisphosphonates in adult patients with HCM.
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Medical management

Antiresorptive therapies
As per ES 2022 guidelines:
Initiate treatment with an IV bisphosphonate or denosumab in adult patients with HCM.
B
Consider preferring denosumab over intravenous bisphosphonates.
B
Consider initiating a combination of calcitonin and an IV bisphosphonate or denosumab as initial therapy in adult patients with severe HCM (serum calcium > 14 mg/dL; 3.5 mmol/L).
C

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  • Intravenous fluids

Specific circumstances

Patients with renal insufficiency: as per ES 2022 guidelines, administer renal dosing of zoledronic acid over 30-60 minutes or renal dosing of pamidronate over 2-24 hours in adult patients with HCM and renal insufficiency (defined as CrCl < 60 mL/min) treated with IV bisphosphonates.

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  • Patients with calcitriol-secreting tumor

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Follow-up and surveillance

Serial clinical and laboratory assessment: as per ES 2022 guidelines, monitor dental hygiene and oral health, including visual examination of the mouth, in the context of the provision of antiresorptive therapy in adult patients with HCM.
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  • Management of refractory/recurrent hypercalcemia