Thanks to Dr. Jarred Reed for an excellent presentation on workup and management of hypercalcemia

Learning Points:

• Clinical manifestations of hypercalcemia include GI (anorexia, N/V), Neuro (weakness, AMS), Renal (polyuria, nephrocalcinosis), and MSK (fractures, osteopenia) symptoms. Causes may be broken down to PTH-mediated and PTH-independent causes.
• Excess PTHrP (also called humoral hypercalcemia of malignancy) is the most common cause of hypercalcemia with non-metastatic solid tumors, and will result in a low or inappropriately normal PTH level.
• The mainstay of management includes aggressive IVF but may require bisphosphonates, calcitonin, and corticosteroids. Use of Lasix is controversial but should largely be utilized to avoid fluid overload.
• Denosumab may be used for refractory cases of hypercalcemia. Denosumab works on the OPG-RANK-RANKL pathway and prevents bone resorption by limiting RANKL driven osteoclast activity.