Humoral hypercalcemia of malignancy: Diagnosis and treatment

The diagnosis of humoral hypercalcemia of malignancy begins with a thorough history and physical examination. After confirming the presence of true hypercalcemia, the diagnostic plan should be developed to include testing such as radiography of the thorax and abdomen; ultrasonography of the abdomen; aspiration cytology of lymph nodes and bone marrow; and, potentially, specialized blood tests to determine parathyroid hormone, parathyroid hormone-related protein, ionized calcium, and calcidiol levels. Supportive therapy with diuresis and additional drug therapy (e.g., diuretics and glucocorticoids as needed) helps protect the body from the detrimental effects of hypercalcemia until an etiologic diagnosis is made and more specific therapy initiated. In refractory cases, other therapies, including salmon calcitonin, bisphosphonates, and sodium bicarbonate, may be indicated. Most patients have a good quality of life while the underlying cancer is in remission.