Table of contents
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 2023).
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Diagnostic investigations
Medical management
Antiresorptive therapies
As per ES 2023 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 2023 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
Patients with parathyroid carcinoma
Follow-up and surveillance
Clinical and laboratory follow-up: as per ES 2023 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