Denosumab for management of severe hypercalcemia in primary hyperparathyroidism.
Anna Eremkina,Julia Krupinova,Ekaterina Dobreva,Anna K. Gorbacheva,Ekaterina Bibik,Margarita Samsonova,Alina Ajnetdinova,Natalya Mokrysheva +7 more
TLDR
The study shows that denosumab is a useful tool in PHPT-associated hypercalcemia before surgery or if surgery is contraindicated, and a significant increase in calcium levels is confirmed.Abstract:
Hypercalcemic crisis is a severe but rare complication of primary hyperparathyroidism (PHPT), and data on denosumab treatment of patients with this disease is still very limited. The aim of this paper is to investigate the hypocalcemic effect of denosumab in PHPT patients with severe hypercalcemia when surgery should be delayed or is impossible for some reasons. We performed a retrospective study of 10 patients. The analysis included the use of biochemical markers of calcium-phosphorus metabolism, which were followed after the administration of 60 mg of denosumab. The trend to calcium reduction was already determined on the 3rd day after denosumab administration. In most cases the decrease in serum calcium level to the range of 2.8 mmol/L on average or lower was observed on the 7th day (P = 0.002). In addition to a significant increase in calcium levels we confirmed a significant increase in the estimated glomerular filtration rate on 7th day (P = 0.012). After that, seven patients underwent successful parathyroidectomy and achieved eucalcemia or hypocalcemia, one patient developed the recurrence of parathyroid cancer after initial surgery, while two patients with severe cardiovascular pathology refused surgery. Our study shows that denosumab is a useful tool in PHPT-associated hypercalcemia before surgery or if surgery is contraindicated.read more
Citations
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[The clinical practice guidelines for primary hyperparathyroidism, short version].
Natalya Mokrysheva,Anna Eremkina,Svetlana Mirnaya,Julia Krupinova,Iya Voronkova,I V Kim,D. G. Beltsevich,N S Kuznetzov,Ekaterina Pigarova,L Ya Rozhinskaya,Mikhail V. Degtyarev,L. V. Egshatyan,P A Rumiantsev,Elena N. Andreeva,M B Аntsiferov,N.V. Markina,I V Kryukova,T L Karonova,S V Lukyanov,I V Sleptcov,N.B. Chagai,Galina A. Melnichenko,Ivan Ivanovich Dedov +22 more
TL;DR: In this paper, the main issues of Russian guidelines for the management of PHPT, approved in 2020, including laboratory and instrumental methods, differential diagnosis, surgical and conservative approach, short-term and long-term follow-up.
Journal ArticleDOI
Hypercalcemia: A Review.
TL;DR: Mild hypercalcemia is typically asymptomatic, while severe hypercalCEmia is associated with nausea, vomiting, dehydration, confusion, somnolence, and coma, as well as poor survival.
Journal ArticleDOI
Hypercalcemia
TL;DR: Asymptomatic hypercalcemia due to primary hyperparathyroidism is managed with parathyroidectomy or observation with monitoring, while severe hyperCalcemia is typically treated with hydration and intravenous bisphosphonates.
ckert JC, Palliative treatment of uncontrollable hypercalcemia due to parathyrotoxicosis: denosumab as rescue therapy.
R Jumpertz,R von Schwartzenberg,Ulf Elbelt,Christian J. Strasburger,Manfred Ventz,K Mai,Tina Kienitz,Lukas Maurer,Thomas Rose,Joachim Spranger +9 more
TL;DR: In this paper, a case presenting with severe hypercalcemia due to parathyrotoxicosis from parathyroid carcinoma treated for the first time using the monoclonal antibody denosumab as a rescue therapy and present long-term follow-up data.
Journal ArticleDOI
Advances in the diagnosis and the management of primary hyperparathyroidism
TL;DR: The parathyroid glands, one of the last organs to be discovered, are responsible for maintaining calcium homeostasis, and they continue to present the clinician with diagnostic and management challenges that are reviewed in this article.
References
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Denosumab for Prevention of Fractures in Postmenopausal Women with Osteoporosis
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TL;DR: Treatment is aimed at lowering the serum calcium concentration by inhibiting bone resorption and increasing urinary calcium excretion, the former accomplished via bisphosphonate therapy and the latter with aggressive hydration.
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Hypercalcemic Crisis: A Clinical Review
TL;DR: Improved outcomes can be attributed to modern diagnostic capabilities, leading to earlier diagnosis, along with the recognition that primary hyperparathyroidism is the most common etiology for hypercalcemic crisis.