Cancer hypercalcemia

Diagnostic testing of adrenocortical fundi on, nonsuppurative thyroiditis, hypercalcemia associated with cancer, acute exacerbations of multiple sderosis (MS)... 

Corticotropin is used for diagnostic testing of adrenocortical function. This drug may also be used for the management of acute exacerbations of multiple sclerosis, nonsuppurative thyroiditis, and hypercalcemia associated with cancer. It is also used as an anti-inflammatory and immunosuppressant drug when conventional glucocorticoid therapy lias not been effective (see Display 50-1). 

Warning associated with the administration of estrogen include an increased risk of endometrial cancer, gallbladder disease, hypertension, hepatic adenoma (a benign tumor of the liver), cardiovascular disease, increased risk of thromboembolic disease and hypercalcemia in those with breast cancer and bone metastases. 

The estrogens are used cautiously in patients with gallbladder disease, hypercalcemia (may lead to severe hypercalcemia in patients with breast cancer and bone metastasis), cardiovascular disease, and liver impairment. 

Tamoxifen can be used in both premenopausal and postmenopausal women with metastatic breast cancer who have tumors that are hormone-receptor-positive. The toxicities of tamoxifen are described in the section on adjuvant endocrine therapy. The only additional toxicity that one might expect to find in the setting of metastatic breast cancer (specifically bone metastases) is a tumor flare or hypercalcemia, which occurs in approximately 5% of patients following the initiation of any SERM therapy and is not an indication to discontinue SERM therapy. It is generally accepted that this is a positive indication that the patient will respond to endocrine therapy. 

Hypercalcemia is the most common metabolic abnormality experienced by patients with cancer. Once hypercalcemia occurs, it is associated with a very poor prognosis owing to the frequent association with advanced or metastatic disease.26... 

Hypercalcemia occurs in 10% to 30% of patients with cancer during the course of their disease. The most common tumor types associated with hypercalcemia are breast cancer squamous cell carcinomas of the head, neck, and lung and renal cancer. 

The delicate balance maintained by these factors is altered in patients with cancer by two principal mechanisms tumor production of humoral factors that alter calcium metabolism (humoral hypercalcemia) and local osteolytic activity from bone metastases.27 Humoral hypercalcemia causes around 80% of all hypercalcemia cases and is mediated primarily by systemic secretion of parathyroid hormone-related protein... 

Stewart AF. Hypercalcemia associated with cancer. New Engl J Med 2005 352 373-379. 

Paraneoplastic syndromes commonly associated with lung cancers include cachexia, hypercalcemia, syndrome of inappropriate antidiuretic hormone secretion, and Cushing s syndrome. 

Cancer and hyperparathyroidism are the most common causes of hypercalcemia. The primary mechanisms are increased bone resorption, increased GI absorption, and decreased renal elimination. 

Breast cancer Androgen therapy may cause hypercalcemia by stimulating osteolysis. 

Endocrine disorders Primary or secondary adrenal cortical insufficiency (hydrocortisone or cortisone is the drug of choice synthetic analogs may be used in conjunction with mineralocorticoids in infancy, mineralocorticoid supplementation is important) congenital adrenal hyperplasia nonsuppurative thyroiditis hypercalcemia associated with cancer. 

Contraindications Cardiac impairment, hypercalcemia, prostatic or breast cancer in males, severe liver or renal disease... 

Estrogen therapy may increase the risk of developing coronary heart disease, hypercalcemia, gallbladder disease, cerebrovascular disease, and breast cancer. 

Edema, nausea, insomnia, oligospermia, priapism, male pattern of baldness, bladder irritability, hypercalcemia in immobilized patients orthose with breast cancer, hypercholesterolemia Rare... 

Stewart AF Clinical practice. Hypercalcemia associated with cancer. N Engl J Med 2005 352 373. [PMID 15673803] Strom TM, Juppner H PHEX, FGF23, DMP1 and beyond. Curr Opin Nephrol Hypertens 2008 17 357. [PMID 18660670] Tfelt-Hanson J, Brown EM The calcium-sensing receptor in normal physiology and pathophysiology A review. Crit Rev... 

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