Endocrine Society Hypercalcemia of Malignancy Guidelines
Cet article présente les recommandations de la Société d'endocrinologie concernant le traitement de l'hypercalcémie liée aux cancers
Hypercalcemia of malignancy (HCM) affects 2% to 30% of patients with cancer and is associated with high morbidity and mortality. Symptoms range from fatigue, constipation, polyuria, and polydipsia with mild-to-moderate hypercalcemia (mild: serum calcium [SCa] level of 10.5 to <12 mg/dL; moderate: SCa level of 12 to
≤
14 mg/dL) to cognitive dysfunction, kidney failure, and arrhythmias with rapidly rising calcium levels or severe hypercalcemia (SCa >14 mg/dL).1 Pathophysiology followed by HCM can include (1) production of parathyroid hormone–related peptides, (2) bone metastases releasing osteoclast activating factors, and (3) excess production of calcitriol.2 Treatment of HCM begins with intravenous (IV) hydration, potent antiresorptive agents (such as bisphosphonates [BPs] and denosumab [Dmab]), and calcitonin for severe hypercalcemia. Following initial treatment, identification and/or treatment of the underlying malignancy is critical for controlling HCM and preventing its recurrence. Hypercalcemia of malignancy due to parathyroid carcinoma may be treated with antiresorptive therapy and/or calcimimetic therapy, depending on the severity. For all forms of HCM, there is uncertainty about the best agents to use, given the particular clinical circumstances, and in what order.
JAMA Oncology , article en libre accès, 2022