Hypercalcemia Guidelines

Updated: Apr 26, 2023
  • Author: Mahendra Agraharkar, MD, MBBS, FACP, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Guidelines Summary

The Endocrine Society has issued guidelines on the management of hypercalcemia of malignancy (HCM) in adults. [30] Recommendations (all but one of them conditional, and all with very low certainty of evidence) are as follows:

  • Intravenous (IV) hydration and IV bisphosphonate or denosumab is recommended (strong recommendation); treatment with denosumab is suggested vs IV bisphosphonate for acute HCM.

  • In severe HCM (serum calcium level >14 mg/dL), combination therapy with calcitonin and an IV bisphosphonate or denosumab is suggested.

  • For refractory or recurrent HCM despite treatment with IV bisphosphonate, denosumab is suggested.

  • For hypercalcemia due to high calcitriol levels with symptomatic or severe hypercalcemia despite glucocorticoid therapy, the addition of IV bisphosphonate or denosumab is suggested.

  • Patients with parathyroid carcinoma can be treated with calcimimetic and/or antiresorptive therapy, depending on the severity and results of initial treatment.