Q:

How do we differentiate malignancy-related hypercalcemia?

waelhammad
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2022-11-19
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A 54-year-old female presents with drowsiness to the emergency. Her BP is 140/90 mm of Hg with pulse after rate 100/minute. Her investigations reveals serum creatinine 2.4 mg/dL, Na 140 mEq/L, K 4.3 mEq/L. Complete blood count (CBC) and liver function test (LFT) is normal. CT scan head is normal. Her past evaluation reveals a cervical lymph node fine needle aspiration cytology (FNAC) suggestive of granulomatous inflammation. Her bone marrow examination is suggestive of non-Hodgkin’s lymphoma.

How do we differentiate malignancy-related hypercalcemia?

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waelhammad
2022-11-19
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What is same as in primary hyperparathyroidism?

↑ Urinary phosphate clearance

Hypophosphatemia

↑ Urinary nephrogenous cAMP excretion

What is different from primary hyperparathyroidism?

↓ PTH (by double antibody technique)

↑ Renal calcium clearance

↓/N levels of ↑ 1,25(OH)2D

Other paraneoplastic syndromes

Elevated levels of PTHrP may be detected

Investigations

Radiology Osteolytic metastases may be seen on X-ray

Tc-labeled bisphosphonate bone scan may detect metastases

BM biopsy in patients with hematological abnormality

Chest X-ray

CT abdomen

Treatment of hypercalcemia is first directed to control of tumor. Reduction of tumor mass usually controls hypercalcemia.

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