Clinical Syndrome of Hypercalcemia in Malignancy

The onset of hypercalcemia in malignancy is usually rapid, and hypercalcemia is often manifested as confusion, stupor, nausea, vomiting, or dehydration. The offending neoplasm is almost always evident clinically, even when hypercalcemia is its initial manifestation. Thus, physical examination, a chest radiograph, complete blood count, and urinalysis disclose the underlying tumor in about 98% of patients. Given these characteristics, it is not surprising that malignancy is the most common cause of hypercalcemia in hospitalized patients but is a rare cause of hypercalcemia in an office practice, which is dominated by patients with primary hyperparathyroidism and other forms of chronic, minimally symptomatic hypercalcemia. Because hypercalcemia usually occurs in advanced malignancy, the prognosis is poor, with a median survival of only 4 to 8 weeks after the discovery of hypercalcemia.7 Exceptions to this rule are breast carcinoma and multiple myeloma. In both these disorders, successful therapy for the underlying malignancy may provide long survival in the hypercalcemic patient.

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