Hypercalcemia of malignancy

Severity

While there is no universally accepted classification of mild, moderate, or severe hypercalcemia, 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 hypercalcemia: total calcium of less than 12 mg/dL (<3 mmol/L) or ionized calcium of 5.6 to 8.0 mg/dL (1.4 to 2.0 mmol/L)

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

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

The National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) classifies hypercalcemia 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 11.5 mg/dL (2.9 mmol/L); ionized calcium >upper limit of normal to 6 mg/dL (1.5 mmol/L)

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

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

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

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