Hypercalcaemia of malignancy

Severity

While there is no universally accepted classification of mild, moderate, or severe hypercalcaemia, the following criteria are widely used:[6]El-Hajj Fuleihan G, Clines GA, Hu MI, et al. Treatment of hypercalcemia of malignancy in adults: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2023 Feb 15;108(3):507-28. https://academic.oup.com/jcem/article/108/3/507/6916871 http://www.ncbi.nlm.nih.gov/pubmed/36545746?tool=bestpractice.com [7]Walker MD, Shane E. Hypercalcemia: a review. JAMA. 2022 Oct 25;328(16):1624-36. http://www.ncbi.nlm.nih.gov/pubmed/36282253?tool=bestpractice.com [8]Carroll MF, Schade DS. A practical approach to hypercalcemia. Am Fam Physician. 2003 May 1;67(9):1959-66. https://www.aafp.org/pubs/afp/issues/2003/0501/p1959.html http://www.ncbi.nlm.nih.gov/pubmed/12751658?tool=bestpractice.com

• Mild hypercalcaemia: total calcium of less than 3 mmol/L (<12 mg/dL) or ionised calcium of 1.4 to 2.0 mmol/L (5.6 to 8.0 mg/dL)

• Moderate hypercalcaemia: total calcium of 3.0 to 3.5 mmol/L (12.0 to 13.9 mg/dL) or ionised calcium of 2.5 mmol/L or greater (≥10 mg/dL)

• Severe hypercalcaemia: 3.5 mmol/L or greater (≥14 mg/dL) or ionised calcium of 2.5 to 3.0 mmol/L (10-12 mg/dL).

The National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) classifies hypercalcaemia of malignancy into four grades premised on corrected serum calcium:[9]US National Cancer Institute: cancer therapy evaluation program. Common terminology criteria for adverse events (CTCAE) v5.0. Nov 2017 [internet publication]. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/ctc.htm

• Grade 1: corrected serum calcium (SCa) of >upper limit of normal* to 2.9 mmol/L (11.5 mg/dL); ionised calcium >upper limit of normal to 1.5 mmol/L (6 mg/dL)

• Grade 2: corrected SCa of >2.9 to 3.1 mmol/L (>11.5 to 12.5 mg/dL); ionised calcium >1.5 to 1.6 mmol/L (>6.0 to 6.4 mg/dL); symptomatic

• Grade 3: corrected SCa of >3.1 to 3.4 mmol/L (>12.5 to 13.5 mg/dL); ionised calcium >1.6 to 1.8 mmol/L (>6.4 to 7.2 mg/dL); hospitalisation indicated

• Grade 4: corrected SCa of >3.4 mmol/L (>13.5 mg/dL); ionised calcium >1.8 mmol/L (>7.2 mg/dL); life-threatening consequences.

*upper limit of normal: serum calcium 2.7 mmol/L (10.8 mg/dL); ionised calcium 1.3 mmol/L (5.3 mg/dL) (values may vary among laboratories)