Hypercalcaemia of Malignancy Flashcards
What is hypercalcaemia?
An adjusted serum calcium of >2.6mmol/L
What is the most common life-threatening metabolic disorder in cancer patients?
Hypercalcaemia of malignancy
Which types of cancer are commonly associated with PTHrP secretion?
- Renal cancer
- Ovarian cancer
- Endometrial cancer
- Squamous cell carcinoma
What are the effects of PTHrP on the body?
- Stimulates osteoclast resorption
- Inhibits osteoblast formation of bone
- Reduces calcium clearance in the kidney
Which cancers are most associated with osteolytic metastases?
- Breast cancer
- Multiple myeloma
What are the three causes of hypercalcaemia in malignancy?
- Secretion of parathyroid hormone-related protein (PTHrP)
- Osteolytic metastases
- Secretion of calcitriol (1,25-dihydroxyvitamin D)
Which type of cancer is associated with the secretion of calcitriol?
Lymphomas
Which cancers are most associated with hypercalcaemia?
- Multiple myeloma
- Breast cancer
- Lung cancer (SCC)
- Renal cancer
- Thyroid (SCC)
- Lymphomas
What medications can worsen hypercalcaemia?
- Thiazide diuretics
- Lithium
- Supplements containing calcium or vitamin D
What are common clinical features of hypercalcaemia?
- Confusion
- Nausea and vomiting
- Fatigue
- Thirst and polyuria
- Constipation
- Anorexia
- Bone pain
- Abdominal pain
- Renal colic
What is the mnemonic for the clinical features of hypercalcaemia?
STONES, BONES, GROANS, AND MOANS
What examination findings may indicate hypercalcaemia?
- Dehydration
- Hyporeflexia
- Tongue fasciculations
- Abdominal distension from constipation
- Bony tenderness
What are the adjusted serum calcium level classifications for hypercalcaemia?
- Mild: <3mmol/L
- Moderate: 3-3.5mmol/L
- Severe: >3.5mmol/L
What ECG changes might be observed in hypercalcaemia?
- Bradycardia
- Shortened QT interval
- Heart block
What are the supportive management measures for hypercalcaemia?
- Stop contributing medications
- Manage symptoms with medications (laxatives, anti-emetics, analgesia)
What is the aggressive rehydration target in the management of hypercalcaemia?
At least 3L in the first 24 hours
Which medications are used specifically for hypercalcaemia management?
- Bisphosphonates
- Zoledronic acid
- Disodium pamidronate
What are the potential complications of hypercalcaemia?
- AKI
- Acute pancreatitis
- Cardiac arrhythmias
- Seizures
- Coma
