What is the mechanism and initial management for hypercalcemia of malignancy?

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Multiple Choice

What is the mechanism and initial management for hypercalcemia of malignancy?

Hypercalcemia of malignancy usually comes from two main mechanisms: tumor secretion of PTHrP (which acts like PTH to increase bone resorption and renal calcium reabsorption) or osteolytic metastases that release calcium from bone and stimulate osteoclasts. In some cancers, excess calcitriol can contribute, but the classic drivers are PTHrP and bone destruction. Initial management focuses on rapid volume repletion with isotonic saline to correct dehydration and promote calciuresis. After rehydration, antiresorptive therapy is key to lowering calcium by inhibiting bone resorption—bisphosphonates ( Pamidronate or Zoledronic acid) are commonly used, or denosumab if bisphosphonates are not suitable or if renal function is a concern. Address the underlying malignancy to prevent recurrence. For quick but temporary relief, calcitonin can be added, and dialysis may be considered in severe renal failure or refractory cases.

Hypercalcemia of malignancy usually comes from two main mechanisms: tumor secretion of PTHrP (which acts like PTH to increase bone resorption and renal calcium reabsorption) or osteolytic metastases that release calcium from bone and stimulate osteoclasts. In some cancers, excess calcitriol can contribute, but the classic drivers are PTHrP and bone destruction.

Initial management focuses on rapid volume repletion with isotonic saline to correct dehydration and promote calciuresis. After rehydration, antiresorptive therapy is key to lowering calcium by inhibiting bone resorption—bisphosphonates ( Pamidronate or Zoledronic acid) are commonly used, or denosumab if bisphosphonates are not suitable or if renal function is a concern. Address the underlying malignancy to prevent recurrence. For quick but temporary relief, calcitonin can be added, and dialysis may be considered in severe renal failure or refractory cases.

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