Cancer-Associated Hypercalcemia
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Hypercalcemia complicates the course of a variety of cancers when tumor factors overwhelm normal calcium and bone homeostasis.
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Cancer-associated hypercalcemia often occurs late in the course of solid-tumor development and portends a poor prognosis.
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Hypercalcemia in the context of cancer may have nonmalignant causes, such as primary hyperparathyroidism; this possibility should be ruled out with the use of appropriate clinical assessment and laboratory testing.
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Because patients with cancer-associated hypercalcemia typically present with profound dehydration, the initial treatment should involve the administration of intravenous fluids.
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Increased osteoclastic bone resorption is almost always responsible for hypercalcemia, regardless of tumor type or mediator; after hydration, the use of bone-resorption inhibitors (most commonly intravenous bisphosphonates) to lower calcium levels is the mainstay of treatment.
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Successful treatment of cancer-associated hypercalcemia ultimately depends on treatment of the underlying cancer.

Source: https://www.nejm.org/doi/full/10.1056/NEJMcp2113128?af=R&rss=currentIssue
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