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Severe prolonged hypocalcaemia following pamidronate for malignant hypercalcaemia
E C Sims1, P B Rogers, G M Besser
1St Bartholomew's Hospital, London, UK.
Clinical Oncology (Royal College of Radiologists (Great Britain))
|January 16, 1999
Summary
Malignant hypercalcemia is common, treated with bisphosphonates. A patient with breast cancer experienced prolonged hypocalcemia after pamidronate, suggesting normal parathyroid function is key for safe treatment.
Area of Science:
- Oncology
- Endocrinology
- Pharmacology
Background:
- Hypercalcemia of malignancy is a frequent complication.
- Bisphosphonates are the primary treatment for hypercalcemia of malignancy.
- Previous parathyroid adenoma surgery can impact calcium homeostasis.
Observation:
- A patient with metastatic breast cancer and hypercalcemia (serum calcium 3.72 mmol/l) was treated with pamidronate.
- This patient had a history of parathyroid adenoma surgery.
- Profound, symptomatic hypocalcemia lasting over 60 days was observed post-treatment.
Findings:
- Bisphosphonate treatment in a patient with a history of parathyroid surgery led to prolonged hypocalcemia.
- The patient's parathyroid reserve may have been compromised by prior surgery.
- This case highlights a potential complication of bisphosphonate therapy in specific patient populations.
Implications:
- A normal parathyroid reserve appears necessary for safe bisphosphonate use in malignant hypercalcemia.
- Careful monitoring of calcium levels is crucial in patients with a history of parathyroid issues undergoing bisphosphonate therapy.
- Further research into managing hypercalcemia in patients with compromised parathyroid function is warranted.