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Hypercalcemia of malignancy

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  • Teoria
  • Diagnóstico
  • Tratamento
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Última revisão das evidências: 17 Feb 2026
Última atualização do tópico: 18 Jul 2023

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • history of malignancy
Detalhes completos

Outros fatores diagnósticos

  • 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
Detalhes completos

Fatores de risco

  • nonmetastatic malignancy
  • metastatic skeletal involvement
  • lymphoma
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • 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
Detalhes completos

Investigações a serem consideradas

  • skeletal survey
  • chest x-ray
完整详情

治疗流程

急症处理

mild hypercalcemia or asymptomatic moderate hypercalcemia

symptomatic moderate or severe hypercalcemia: without advanced kidney disease

symptomatic moderate or severe hypercalcemia: with advanced kidney disease

撰稿人

作者

Albert Shieh, MD

Assistant Professor of Medicine

Division of Geriatric Medicine

Department of Medicine

University of California, Los Angeles

Los Angeles

CA

利益声明

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

利益声明

DM declares that she has no competing interests.

同行评议者

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

利益声明

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

利益声明

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).

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Cancer Institute NSW. Hypercalcaemia of malignancy (HCM). Jul 2019 [internet publication].全文

Guise TA, Wysolmerski JJ. Cancer-associated hypercalcemia. N Engl J Med. 2022 Apr 14;386(15):1443-51. 摘要

Horwitz MJ. Chapter 84: Non-parathyroid hypercalcemia. In: Bilezikian JP, ed. Primer on the metabolic bone diseases and disorders of mineral metabolism. 9th ed. Washington, DC: American Society of Bone and Mineral Research; 2018:639-45.

El-Hajj Fuleihan G, Clines GA, Hu MI, et al. Treatment of hypercalcemia of malignancy in adults: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2023 Feb 15;108(3):507-28.全文  摘要

Stewart AF. Clinical practice. Hypercalcemia associated with cancer. N Engl J Med. 2005 Jan 27;352(4):373-9. 摘要

Alberta Provincial Tumour Council. Oncologic emergencies: a guide for family physicians. Sep 2014 [internet publication].全文

Society for Endocrinology. Emergency management of acute hypocalcaemia in adult patients. Sep 2016 [internet publication].全文

Horwitz MJ, Hodak SP, Steward AF. Non-parathyroid hypercalcemia. In: Rosen CJ, ed. Primer on the metabolic bone diseases and disorders of mineral metabolism. 8th ed. Washington, DC: American Society of Bone and Mineral Research; 2013:562-71.

Major P, Lortholary A, Hon J, et al. Zoledronic acid is superior to pamidronate in the treatment of hypercalcemia of malignancy: a pooled analysis of two randomized, controlled clinical trials. J Clin Oncol. 2001 Jan 15;19(2):558-67. 摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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