Resident Report – 4/6 HyperCA with MM

Teaching Points

  • Symptoms of hypercalcemia include constipation, delayed reflexes, lethargy, confusion
  • Etiologies for hypercalcemia (top 2) include:
    • Primary hyperparathyroidism
    • Malignancy
  • Hypercalcemia secondary to malignancy can arise by different mechanisms:
    • PTHrP
      • Many of your solid tumors
      • Non-Hodgkin’s lymphoma
    • Bone Disease
      • Breast cancer
      • Multiple myeloma
    • Increased production of active Vitamin D
      • Hodgkin’s lymphoma
  • Management of hypercalcemia of malignancy includes the following:
    • IV fluids for immediate effect
      • Many patients with high calcium levels are dehydrated.
      • This is due to hypercalcemia causing nephrogenic DI picture.
    • Calcitonin
      • Works within hours
      • Prone to tachyphylaxis
    • Bisphosphonates
      • Takes up to 48 hours before effect is seen
      • Pamidronate or Zolendronate
      • Caution in use for renal failure
    • Lasix
      • Only used in the setting of symptomatic hypervolemia.
  • Diagnosis of Multiple Myeloma includes the following:
    • M-spike
    • Bone marrow biopsy with >10% plasma cells
    • Clinical manifestations based on the CRAB criteria:
      • HyperCalcemia – 25%
      • Renal dysfunction – 50%
      • Anemia – 75%
      • Bone involvement – 50%

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