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Hypercalcemia of malignancy

Last reviewed: 21 Oct 2024
Last updated: 18 Jul 2023

Summary

Definition

History and exam

Key diagnostic factors

  • history of malignancy
Full details

Other diagnostic factors

  • normal physical exam
  • poor skin turgor and/or dry mucous membranes
  • confusion
  • fatigue
  • constipation
  • loss of appetite
  • nausea
  • polyuria
  • polydipsia
  • bone pain
  • use of hypercalcemia-inducing medication
  • stupor
  • coma
Full details

Risk factors

  • nonmetastatic malignancy
  • metastatic skeletal involvement
  • lymphoma
Full details

Diagnostic tests

1st tests to order

  • total serum calcium
  • serum ionized calcium
  • serum albumin
  • comprehensive metabolic panel
  • resting ECG
  • serum intact parathyroid hormone
  • serum parathyroid hormone-related peptide
  • serum phosphorus
  • serum calcitriol (1,25-dihydroxyvitamin D)
  • serum 25-hydroxyvitamin D
Full details

Tests to consider

  • skeletal survey
  • chest x-ray
Full details

Treatment algorithm

ACUTE

mild hypercalcemia or asymptomatic moderate hypercalcemia

symptomatic moderate or severe hypercalcemia: without advanced kidney disease

symptomatic moderate or severe hypercalcemia: with advanced kidney disease

Contributors

Authors

Albert Shieh, MD

Assistant Professor of Medicine

Division of Geriatric Medicine

Department of Medicine

University of California, Los Angeles

Los Angeles

CA

Disclosures

AS declares that he has no competing interests.

Dorothy Martinez, MD

Clinical Professor of Medicine

Division of Endocrinology

Department of Medicine

University of California, Los Angeles

Los Angeles

CA

Disclosures

DM declares that she has no competing interests.

Peer reviewers

Ken C. Chiu, MD, FACE

Professor

Endocrinology Fellowship Training Program

Department of Clinical Diabetes, Endocrinology, and Metabolism

City of Hope National Medical Center

Duarte

CA

Disclosures

KCC declares that he has no competing interests.

Richard Quinton, MD

Consultant and Senior Lecturer

Endocrine Unit

Newcastle University and Royal Victoria Infirmary

Newcastle-upon-Tyne

UK

Disclosures

RQ has been reimbursed by Amgen, the manufacturer of Cinacalcet, for attending a conference and for giving an educational seminar (total under £1,200 over past 3 years).

  • Hypercalcemia of malignancy images
  • Differentials

    • Primary hyperparathyroidism
    • Hyperthyroidism
    • Adrenal insufficiency
    More Differentials
  • Guidelines

    • Cancer guidelines: symptom management. Oncologic emergencies
    • Treatment of hypercalcemia of malignancy in adults: an Endocrine Society clinical practice guideline
    More Guidelines
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