Hypercalcaemia: historical perspectives and present management

Hypercalcaemia is a well-recognised complication in patients with several types of cancer. Since determination of the serum calcium has become routine particularly in hospital patients, the identification of hypercalcaemia associated with cancer has increased. Cancer is the most common cause of hypercalcaemia arising in hospitalised patients, and overall approximately one-third of all patients presenting with hypercalcaemia have an underlying cancer. In Western countries, the common causes of hypercalcaemia are cancers of the lung and breast. The median survival of patients with hypercalcaemia and cancer is only 5 weeks, indicating that in many patients treating hypercalcaemia may not achieve prolonged survival, even if symptoms are palliated. The clinical presentations of hypercalcaemia are well known, encompassing gastrointestinal, neurological, cardiovascular and renal symptoms. Management approaches have evolved over the past few years from hydration and use of drugs that promote calcium excretion to new treatments that inhibit bone resorption.