[Hypercalcemia in hospitalized patients. Diagnostic and prognostic aspects]

Abstract

Over a period of 6 1/2 years hypercalcemia has been diagnosed in 86 patients. In 55.8% of cases a malignant tumor was the cause of the elevated calcium levels, and in 22.1% of cases primary hyperparathyroidism (p.Hp.) was diagnosed. In the remaining 19 patients hypercalcemia was related to renal insufficiency (5 patients), vitamin-D intoxication (4) and thiazide therapy (3), while other, rarer causes were identified in 7 cases. As expected, bronchial and breast carcinomas were most frequent (52%) in the malignancy group. In patients below age 40 malignancy was never responsible for the hypercalcemia, but in patients over 50 malignancy was present in 65%. Of the patients with solid tumors 54.8% had skeletal metastases, while other organ metastases were found in 33.3% of these. The occurrence of a hypercalcemia in patients with malignancy is associated with a poor prognosis since over 60% of the patients died within as little as one month and over 90% within a year after the occurrence of hypercalcemia. Renal function impairment in hypercalcemia was significantly more marked in the patients with malignancy than in patients with p.Hp. and was closely related to the calcium levels. Pharmacological reduction of the blood calcium level produced a distinct improvement in renal function in 70% of the patients treated. The current hypothesis on the pathogenesis of hypercalcemia among carcinoma patients is briefly discussed.