CDHB
A high proportion of hypercalcaemic patients will have an associated underlying malignancy, the commonest being breast cancer, lung cancer and myeloma. Some 10-20% of patients with cancer will become hypercalcaemic at some time during their course. Notably some malignancies, which may be cured or have a prolonged remission, may re-present with hypercalcaemia. Therefore, any patient with hypercalcaemia who either has or is suspected of having an underlying malignancy should be referred promptly to an Oncologist or Haematologist.
The measures described in Endocrinology (see Hypercalcaemia) are appropriate, but where possible the underlying cause must also be treated. The hypercalcaemia of most malignancies will not be controlled satisfactorily unless the cancer is treated specifically. In particular, the hypercalcaemia associated with myeloma, breast cancer, or lymphoma often resolves within 24-48 hours of specific chemotherapy.
Treatment of hypercalcaemia of malignancy requires rehydration followed by 4 mg zoledronic acid over 15 mins by IV infusion.
Topic Code: 1562