Hypercalcemia of Malignancy

Hypercalcemia of Malignancy – General Information

Hypercalcemia of Malignancy – Symptoms

Hypercalcemia of Malignancy – Treatment

The available treatment for Hypercalcemia of Malignancy depends on the stage, the severity and the exact cause of the problem. There are cases in which the patient presents moderate levels of calcium, and there are few treatment options for them. To know for sure what the cause of the disease is, the doctor can perform a physical evaluation, consisting in a subsequent timely follow up visit. The main goals of the treatment are to control and reduce the level of calcium, to maintain an adequate hydration, to increase urinary calcium excretion, to inhibit the osteoclast activity in the bone, and to treat the underlying cause of the condition. The first step to treat patients who suffer from a severe form of the condition is hydration with saline. This procedure decreases the calcium levels through dilution. The process also causes an expansion of extracellular volume which increases the renal calcium excretion. This therapy is based on several factors such as severity of Hypercalcemia of Malignancy, severity of dehydration, the ability of the patient to tolerate rehydration, which makes very important to prevent volume overload.

Hydration is considered ineffective when is administered on patients who suffer from kidney failure because diuresis is impossible. The best way to treat the disease in patients who suffer from renal failure is the dialysis procedure. There are cases in which the doctor can use loop diuretics to treat Hypercalcemia of Malignancy. This kind of medication, prescribed usually as furosemide, can be used in combination with the hydration therapy to increase calcium excretion. This combination also prevents volume overload during the therapy. The use of thiazide diuretics is certainly contraindicated because they increase the resorbtion of calcium. There are cases in which the doctor can prescribe a treatment trial with bisphosphates, which are agents that help inhibiting the osteoclast activity that should be followed for at least one month. Usually, patients who suffer from renal failure or heart failure are not able to resist to the fluid hydration therapy or several certain medications. In these cases, the best way to decrease the elevation of calcium is urgent dialysis, which is generally made by a nephrologist. There are cases in which the patient suffers from primary hyperparathyroidism and may require surgical procedures to eliminate Hypercalcemia of Malignancy, but in these cases, surgery does not need to be made on an urgent basis. There are other treatment options to treat the condition and can include surgery, chemotherapy, or radiation treatment. The medication part of the treatment is used to treat mild cases of life threatening calcium elevations, but they can also be used to control the elevations after the mild case has been treated. The most common medications used to treat Hypercalcemia of Malignancy include bisphosphonates, prescribed as pamidronate, zoledronic and etidronate, antidotes, prescribed as calcitonin, gallium nitrate and plicamycin, phosphate salts, prescribed as potassium phosphate, corticosteroids, prescribed as hydrocortisone, calcimimetic agents, prescribed as cinacalcet. It is important to monitor the patient’s medical status to see if the medications have the expected effect.