Abstract

Severe hypercalcemia is a medical emergency that requires immediate and aggressive management. Primary hyperparathyroidism (PHPT) often causes severe hypercalcemia. Volume resuscitation, parenteral salmon calcitonin, and administration of intravenous bisphosphonates are common measures used to stabilize patients. However, the use of these measures is inadequate in several patients and may even be contraindicated in individuals with renal insufficiency or severe systemic illness. This study demonstrated the efficacy and safety of denosumab in patients with severe hypercalcemia due to PHPT, when immediate surgery was not feasible. We present four patients with severe hypercalcemia due to PHPT. Immediate surgery was not feasible because the patients had severe systemic illness, such as seizures and altered sensorium (case 1); acute severe pancreatitis (cases 2 and 3); or coronavirus disease 2019 pneumonia (case 4). Intravenous normal saline and parenteral salmon calcitonin were inadequate for controlling hypercalcemia. Intravenous bisphosphonates were avoided because of severe systemic illness in all cases and impaired renal function in three cases. Denosumab was administered to control hypercalcemia and allow the stabilization of patients for definitive surgical management. Following denosumab administration, serum calcium levels normalized, and general condition improved in all patients. Three patients underwent parathyroidectomy after two weeks and another patient after eight weeks. The use of denosumab for the management of severe hypercalcemia due to PHPT is efficacious and safe in patients when immediate surgical management is not feasible due to severe systemic illness.

Highlights

  • Denosumab is a human monoclonal antibody that binds and inactivates receptor activator of nuclear factor kappa-B ligand (RANKL), suppressing osteoclast-induced bone resorption

  • Primary hyperparathyroidism (PHPT), a mostly benign condition caused by parathyroid adenoma, can present with life-threatening hypercalcemia, defined as a serum total calcium level > 14 mg/dL

  • Denosumab, which is excreted by the reticuloendothelial system, is being tested as a bridge therapy until the patient is stable for parathyroidectomy

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Summary

SUMMARY

Severe hypercalcemia is a medical emergency that requires immediate and aggressive management. Parenteral salmon calcitonin, and administration of intravenous bisphosphonates are common measures used to stabilize patients. The use of these measures is inadequate in several patients and may even be contraindicated in individuals with renal insufficiency or severe systemic illness. This study demonstrated the efficacy and safety of denosumab in patients with severe hypercalcemia due to PHPT, when immediate surgery was not feasible. Intravenous normal saline and parenteral salmon calcitonin were inadequate for controlling hypercalcemia. Denosumab was administered to control hypercalcemia and allow the stabilization of patients for definitive surgical management. The use of denosumab for the management of severe hypercalcemia due to PHPT is efficacious and safe in patients when immediate surgical management is not feasible due to severe systemic illness

INTRODUCTION
CASE REPORTS
Parathyroid adenoma
All four parathyroid glands were enlarged
DISCUSSION
Number of patients
Full Text
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