Medline: 1900408

Archives of Internal Medicine 151(3): 437-438, 1991.

Malignant hypercalcemia: the choice of therapy.

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The pathogenesis and treatment of malignant hypercalcemia is briefly discussed. Malignant hypercalcemia is the most common life-threatening metabolic disorder associated with cancer. If not treated, clinical deterioration can be very rapid (profound vol depletion, azotemia, neuromuscular irritability, and progressive obtundation). Proper treatment can lead to near total resolution of symptoms in a short period of time. Cytoreductive chemotherapy is the treatment of first choice for cancer-related malignant hypercalcemia, since increased bone resorption due to malignant skeletal invasion is a primary underlying cause of this syndrome. Unfortunately, this approach is often not possible since cancer patients (pts) afflicted with malignant hypercalcemia frequently have advanced disease and have often already failed cytotoxic therapy. In the vast majority of cases, restoration of plasma volume, enhanced calciuresis, and vigorous iv hydration represents a realistic alternative. Although effective under acute conditions, such therapy can be expected to achieve normal plasma calcium levels in 30% of pts or less. In the remainder, additional therapeutic intervention with agents such as etidronate (an inhibitor of osteolysis) may be required. Since most pts with cancer-related malignant hypercalcemia succumb to progression of underlying disease rather than to hypercalcemia itself, it is only for those cancer pts for whom effective chemotherapy exists that effective management of malignant hypercalcemia can be expected to improve the long-term clinical picture. (16 Refs)

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Rheinische Friedrich- Wilhelms- Universität Bonn
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Dr. G. Quade