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Hypercalcaemia - presentation and management .
1Department of Diabetes & Endocrinology, Norfolk and Norwich University Hospital; Norwich Medical School; NIHR CRN:Eastern Research Network, Norwich, UK. jeremy.turner@nnuh.nhs.uk.
Clinical Medicine (London, England)
|June 3, 2017
Summary
Hypercalcemia, often caused by primary hyperparathyroidism (PHPT), requires prompt management. New treatments like denosumab offer alternatives when saline hydration is insufficient for emergency cases.
Area of Science:
- Endocrinology
- Genetics
- Oncology
Background:
- Hypercalcemia is a frequent condition, primarily resulting from primary hyperparathyroidism (PHPT) or malignancy.
- Emergency presentations of hypercalcemia carry a substantial mortality risk.
- Current emergency management involves saline rehydration, bisphosphonates, and denosumab.
Purpose of the Study:
- To review the management of hypercalcemia, focusing on emergency treatment and underlying causes.
- To highlight the genetic basis of PHPT in younger individuals.
- To discuss current treatment guidelines for PHPT.
Main Methods:
- Literature review of hypercalcemia management strategies.
- Analysis of genetic predispositions in PHPT.
- Summary of consensus statements on asymptomatic PHPT management.
Main Results:
- Intravenous saline is the initial emergency treatment, with bisphosphonates and denosumab used if inadequate.
- Genetic screening is recommended for PHPT cases under 45, with nine causative genes identified.
- Parathyroidectomy is curative but reserved for a minority of PHPT cases; conservative management is often sufficient.
Conclusions:
- Effective management of hypercalcemia involves addressing the underlying cause and employing appropriate acute and long-term strategies.
- Genetic testing plays a role in identifying predispositions for PHPT in specific patient groups.
- Updated consensus guidelines support conservative management for many asymptomatic PHPT cases.
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