Paraneoplasia

Question 1

What are the major components in managing hypercalcemia of malignancy in addition to treating the actual malignancy?

Answer 1

• Maintenance fluids
• Calcitonin
• Zoledronate or denosumab

Question 2

Certain cancers (e.g., SCC of the lung) are associated with what substance that can lead to hypercalcemia of malignancy?

Answer 2

Parathyroid-hormone related protein

Question 3

When evaluating a patient with hypercalcemia, what is the first question to ask in terms of working up the etiology?

Answer 3

Is PTH suppressed or not?

Question 4

A patient with a calcium of 13.7 has a PTH of 7.0. What are the main etiologies on your differential?

Answer 4

• Malignancy
• Granulomatous disease
• Vitamin-D intoxication

Question 5

Why can calcitonin and zoledronate be useful to use together in managing hypercalcemia of malignancy?

Answer 5

1. The calcitonin is only useful for 1-3 days *
2. The zoledronate will take a few days to take effect

*This is because calcitonin’s effects are diminished over time by tachyphylaxis. But i can be used while waiting for the zoledronate to reach full effect.

Question 6

What scoring system can be used to make the diagnosis of TLS?

Answer 6

The Cairo-Bishop score

Question 7

What leukocytic cell line is often diminished in patients with AML?

Answer 7

Neutrophils