A Multimodal Approach Using Calcitonin, Denosumab, and Hemodialysis for the Management of Refractory Hypercalcemia in Malignancy
https://doi.org/10.15605/jafes.041.S1
- Author:
Nur Haziqah Baharum
1
;
Mohd Hazriq A.
1
;
Aimi Fadilah M.
1
;
Nur Aini Eddy Warman
1
;
Fatimah Zaherah MS
1
;
Rohana A.G.
1
Author Information
1. Endocrine Unit, Faculty of Medicine, University Technology MARA (UiTM)
- Publication Type:Journal Article
- MeSH:
Calcitonin;
Denosumab;
Hypercalcemia;
Renal Dialysis;
Neoplasms
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):78-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Severe hypercalcemia is a life-threatening metabolic
emergency that necessitates prompt initiation of systemic
therapy due to the risk of cardiac arrhythmias. It is
frequently linked to squamous cell carcinoma through the
production of parathyroid hormone–related protein, which
mediates the development of humoral hypercalcemia of
malignancy.
Case:This is a case of a 38-year-old male who was diagnosed
1 year ago with locally advanced poorly differentiated
basaloid squamous cell carcinoma of the lower anterior
mandibular alveolus involving cortical, medullary bone,
and perineural invasion. He underwent extensive tumor
resection with reconstruction, tracheostomy, and bilateral
neck dissection, followed by multiple revision surgeries
for postoperative complications. He completed adjuvant
chemoradiotherapy.
He presented with acute confusion without other systemic
symptoms. His Glasgow Coma Scale was E4V4M5. Neurological and systemic examinations were unremarkable, and
oral cavity assessment showed no evidence of recurrence.
Investigations revealed severe hypercalcemia (5.94 mmol/L)
with normal phosphate (1.16 mmol/L) associated with
shortened QTc. Other tests were unremarkable, with no
evidence of infection, uremia, liver dysfunction, or alternative metabolic causes. Lumbar puncture was unremarkable.
His parathyroid hormone level was suppressed at 0.50 pg/
mL. Computed tomography brain showed no evidence of
meningoencephalitis, hydrocephalus, cerebral oedema, or
metastasis. Aggressive hydration was initiated alongside
subcutaneous calcitonin, which was subsequently titrated.
However, there was no clinical or biochemical improvement
after 1 day, with persistent confusion and calcium remaining
at 5.87 mmol/L. Subcutaneous denosumab was then
administered, and hemodialysis was initiated on alternate
days due to refractory hypercalcemia. This resulted in improvement of calcium levels to 3.2–3.6 mmol/L and
resolution of confusion
Conclusion:Refractory hypercalcemia may represent a late manifestation of advanced squamous cell carcinoma and is an
ominous prognostic indicator, necessitating prompt
evaluation and oncologic management.
- Full text:2026080411335691412EP_A106.pdf
