Intravenous hydration and pharmacological therapy for malignancy-associated hypercalcaemia can provide transient restoration of normocalcaemia. Eradication of underlying malignancy is crucial for permanent reversal of hypercalcaemia.
Humoral hypercalcaemia of malignancy or local osteolytic hypercalcaemia
Intravenous hydration and calcitonin may improve hypercalcaemia within the first 24-48 hours of therapy.[1]Stewart AF. Clinical practice. Hypercalcemia associated with cancer. N Engl J Med. 2005 Jan 27;352(4):373-9.
http://www.ncbi.nlm.nih.gov/pubmed/15673803?tool=bestpractice.com
[28]Ljunghall S. Use of clodronate and calcitonin in hypercalcemia due to malignancy. Recent Results Cancer Res. 1989;116:40-5.
http://www.ncbi.nlm.nih.gov/pubmed/2527399?tool=bestpractice.com
[29]Chevallier B, Peyron R, Basuyau JP, et al. Human calcitonin in neoplastic hypercalcemia. Results of a prospective randomized trial [in French]. Presse Med. 1988 Dec 17;17(45):2375-7.
http://www.ncbi.nlm.nih.gov/pubmed/2974978?tool=bestpractice.com
Intravenous bisphosphonates are most efficacious and may restore normocalcaemia within 10 days of treatment in the majority of patients.[1]Stewart AF. Clinical practice. Hypercalcemia associated with cancer. N Engl J Med. 2005 Jan 27;352(4):373-9.
http://www.ncbi.nlm.nih.gov/pubmed/15673803?tool=bestpractice.com
[26]Major P, Lortholary A, Hon J, et al. Zoledronic acid is superior to pamidronate in the treatment of hypercalcemia of malignancy: a pooled analysis of two randomized, controlled clinical trials. J Clin Oncol. 2001 Jan 15;19(2):558-67.
http://www.ncbi.nlm.nih.gov/pubmed/11208851?tool=bestpractice.com
Duration of effect is variable.[26]Major P, Lortholary A, Hon J, et al. Zoledronic acid is superior to pamidronate in the treatment of hypercalcemia of malignancy: a pooled analysis of two randomized, controlled clinical trials. J Clin Oncol. 2001 Jan 15;19(2):558-67.
http://www.ncbi.nlm.nih.gov/pubmed/11208851?tool=bestpractice.com
Sustained resolution of hypercalcaemia requires effective anti-tumour therapy.
Calcitriol (1,25-dihydroxyvitamin D)-mediated hypercalcaemia
Intravenous hydration and calcitonin may transiently improve hypercalcaemia within the first 24-48 hours of therapy.[1]Stewart AF. Clinical practice. Hypercalcemia associated with cancer. N Engl J Med. 2005 Jan 27;352(4):373-9.
http://www.ncbi.nlm.nih.gov/pubmed/15673803?tool=bestpractice.com
[28]Ljunghall S. Use of clodronate and calcitonin in hypercalcemia due to malignancy. Recent Results Cancer Res. 1989;116:40-5.
http://www.ncbi.nlm.nih.gov/pubmed/2527399?tool=bestpractice.com
[29]Chevallier B, Peyron R, Basuyau JP, et al. Human calcitonin in neoplastic hypercalcemia. Results of a prospective randomized trial [in French]. Presse Med. 1988 Dec 17;17(45):2375-7.
http://www.ncbi.nlm.nih.gov/pubmed/2974978?tool=bestpractice.com
Glucocorticoid therapy requires several days to improve serum calcium levels.[34]Binstock ML, Mundy GR. Effect of calcitonin and glutocorticoids in combination on the hypercalcemia of malignancy. Ann Intern Med. 1980 Aug;93(2):269-72.
http://www.ncbi.nlm.nih.gov/pubmed/7406378?tool=bestpractice.com
Duration of effect has not been extensively studied.