PURPOSE: Hypercalcemia is a frequent finding in cancer patients and can be observed in any type of cancer. The physician in charge of cancer patients often ignores non-malignant causes of hypercalcemia. Our objective was to review the causes of hypercalcemia in a large series of cancer patients. METHODS: We have retrospectively studied in a Cancer Centre all consecutive hypercalcemic (Ca> 10.5 mg/dl) patients over an 8-year period. Of 699 evaluated patients, 642 were analyzed after exclusion of patients whose hypercalcemia resolved after rehydration or who had a normal Ca level after correction for protein concentrations. Clinical information was gathered on the type of cancer, its histology, whether the disease was active or in complete remission, and on the presence of bone metastases. Biochemical data included serum Ca, P(i), proteins in all patients, PTH in most patients, and PTHrP, 25OH-Vitamin D, 1,25(OH)(2)-Vitamin D, TSH, and T4 in selected cases. RESULTS: By order of decreasing frequency, the main causes of hypercalcemia were cancer (69.0 %), primary hyperparathyroidism (24.6 %), hyperthyroidism (2.2 %), milk alkali syndrome (0.9 %), and sarcoidosis (0.45 %). In cancer-related causes, bone metastases accounted for 53.0 % of the cases, humoral hypercalcemia of malignancy (HHM) for 35.3 % while there were 11.7 % of cases apparently due to both HHM and bone metastases. Hypercalcemia was not due to cancer in 97 % (84/87) of the patients who were in complete remission. Even in patients with active neoplastic disease, the number of patients whose hypercalcemia was not due to cancer remained clinically relevant (115/555 = 20.5 %). In the 158 patients with primary hyperparathyroidism, 92 patients were in complete remission and 66 patients had active neoplastic disease. CONCLUSIONS: In this large series of hypercalcemia in cancer patients, the cause was not due to cancer in almost one third of the cases. Most patients considered to be in complete remission had hypercalcemia due to a benign condition. In that perspective, serum PTH determination is essential in the approach of hypercalcemic cancer patients since primary hyperparathyroidism is by far the first non-malignant cause of hypercalcemia.
PURPOSE:Hypercalcemia is a frequent finding in cancerpatients and can be observed in any type of cancer. The physician in charge of cancerpatients often ignores non-malignant causes of hypercalcemia. Our objective was to review the causes of hypercalcemia in a large series of cancerpatients. METHODS: We have retrospectively studied in a Cancer Centre all consecutive hypercalcemic (Ca> 10.5 mg/dl) patients over an 8-year period. Of 699 evaluated patients, 642 were analyzed after exclusion of patients whose hypercalcemia resolved after rehydration or who had a normal Ca level after correction for protein concentrations. Clinical information was gathered on the type of cancer, its histology, whether the disease was active or in complete remission, and on the presence of bone metastases. Biochemical data included serum Ca, P(i), proteins in all patients, PTH in most patients, and PTHrP, 25OH-Vitamin D, 1,25(OH)(2)-Vitamin D, TSH, and T4 in selected cases. RESULTS: By order of decreasing frequency, the main causes of hypercalcemia were cancer (69.0 %), primary hyperparathyroidism (24.6 %), hyperthyroidism (2.2 %), milk alkali syndrome (0.9 %), and sarcoidosis (0.45 %). In cancer-related causes, bone metastases accounted for 53.0 % of the cases, humoral hypercalcemia of malignancy (HHM) for 35.3 % while there were 11.7 % of cases apparently due to both HHM and bone metastases. Hypercalcemia was not due to cancer in 97 % (84/87) of the patients who were in complete remission. Even in patients with active neoplastic disease, the number of patients whose hypercalcemia was not due to cancer remained clinically relevant (115/555 = 20.5 %). In the 158 patients with primary hyperparathyroidism, 92 patients were in complete remission and 66 patients had active neoplastic disease. CONCLUSIONS: In this large series of hypercalcemia in cancerpatients, the cause was not due to cancer in almost one third of the cases. Most patients considered to be in complete remission had hypercalcemia due to a benign condition. In that perspective, serum PTH determination is essential in the approach of hypercalcemic cancerpatients since primary hyperparathyroidism is by far the first non-malignant cause of hypercalcemia.
Authors: J L Motellón; F Javort Jiménez; F de Miguel; M J Jaras; A Díaz; J Hurtado; P Esbrit Journal: Clin Chim Acta Date: 2000-01-05 Impact factor: 3.786
Authors: R Rizzoli; D Thiébaud; N Bundred; M Pecherstorfer; Z Herrmann; H J Huss; F Rückert; C Manegold; M Tubiana-Hulin; E U Steinhauer; M Degardin; B Thürlimann; M R Clemens; H Eghbali; J J Body Journal: J Clin Endocrinol Metab Date: 1999-10 Impact factor: 5.958
Authors: S R Nussbaum; J Younger; C J Vandepol; R F Gagel; M A Zubler; R Chapman; I C Henderson; L E Mallette Journal: Am J Med Date: 1993-09 Impact factor: 4.965
Authors: Victor M Gastanaga; Lee S Schwartzberg; Rajul K Jain; Melissa Pirolli; David Quach; Jane M Quigley; George Mu; W Scott Stryker; Alexander Liede Journal: Cancer Med Date: 2016-06-05 Impact factor: 4.452
Authors: Łukasz Gwadera; Adam Jerzy Białas; Mikołaj Aleksander Iwański; Paweł Górski; Wojciech Jerzy Piotrowski Journal: Chron Respir Dis Date: 2019 Jan-Dec Impact factor: 2.444