Hypercalcemia: A complicated puzzle

Abstract

This is a mini-review concerning hypercalcemia of malignancy that represents a challenging condition requiring rapid management, not only in relationship with short term complications, but also with long term mortality concerning the originating tumor approach (if feasible). Hypercalcemia on a patient with previously known or unknown cancer may be caused by dehydration, concurrent medication causing increased serum calcium levels, concomitant primary or renal hyperparathyroidism, over production of vitamin D (which may be tumor-related) or by specific circumstances that induce suppression of parathormone (PTH), so called PTH-independent mechanisms. Specific circumstances related to an active cancer means an ectopic production of parathormone, metastasis causing osteolytic lesions, tumors that produce PTHrP (parathormone related peptide) and abnormal production of 1,25-dihydroxyvitamin D by a hematologic malignancy. Parathyroid carcinoma induces an excess of PTH which is caused by a malignancy but it is not a PTH independent entity. Once a malignancy-related hypercalcemia is identified based on biological panel (mostly blood assays), the investigations are essentially continued with different imaging techniques depending on signs (if any), accessibility, etc. The approach is based on a multidisciplinary panel, on one hand, in order to restore normal levels of calcium, on the other hand, to rapidly address the underlying cause. This is essential to contribute to the outcome which typically is poor.

Natural History of Non-Functioning Pituitary Adenomas: A Systematic Review and Meta-Analysis

“…Tumor shrinkage was observed with an incidence between 1.3 to 19.7/100 PYs (I 2 = 80%), however, removing one outlier 24 the incidence of tumor shrinkage across studies was estimated to 3.7/100 PYs as shown in Table 3 , while the overall risk of recovery of any pituitary function was estimated to 1.2/100 PYs.…”

“…The last search was conducted the 7th of May 2023 and as shown in Fig. 1 , Table 1 , and Table S2 , we included 35 publications reporting on 30 studies 4 5 11 12 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 . The included studies represent data from 1957 patients with NFPTs who were initially treated conservatively and followed for a mean of 4.0 (SD 1.5) years.…”

“…0.8 to 2.4; I 2 = 49%) 3 One outlier removed, Arita et al 21 , changing the estimate to 0.4/100 PYs (95% Cl. 0.1 to 0.8; I 2 = 32%) 4 One outlier removed, Carsote et al 24 , changing the estimate to 3.7/100 PYs (95% Cl. 2.6 to 4.7; I 2 = 74%) PYs: Person years.…”