Hypercalcaemia of malignancy

• What is hypercalcaemia of malignancy?


  Paraneoplastic syndrome

  -> often associated with breast cancer, lung cancer & multiple myeloma
• Pathophys of hypercalcaemia of malignancy


  Tumour secretion of parathyroid hormone-related protein (PTHrP), leading to:

  • Increased bone resorption
  • Renal tubular calcium reabsorption

  May also arise due to local osteolytic activity or ectopic production of calcitriol in some lymphomas
• What are the signs & symptoms of hypercalcaemia of malignancy?


  Polyuria

  Polydipsia

  Constipation

  Nausea

  Neuropsychiatric symptoms (confusion, lethargy)

  Coma (severe)

  Cardiac arrhythmias (severe)
• What is the treatment & mangement of hypercalcaemia of malignancy?


  Hydration

  Bisphosphonates or denosumab to inhibit osteoclast activity

  Corticosteroids (in certain contexts)

  Haemodialysis (in refractory cases or when rapid calcium reduction is needed).