Moffitt Hem-Onc Report Pearls 7.14.17

Thank you, Brett, for presenting a case of an elderly female with recent treatment for community acquired pneumonia, with ongoing shortness of breath and fatigue found to have severe hypercalcemia.

Key Pearls:

  1. Appendectomy is curative for most small appendiceal carcinoid tumors.
  2. We reviewed the diagnostic approach to hypercalcemia. Management is summarized below as well.
  3. While waiting for your PTH to come back, you can look at the chloride to phosphate ratio to get a clue about whether hypercalcemia is PTH-independent. Remember that PTH will increase phosphaturia, thus resulting in a high chloride to phosphate ratio. If the ratio is <35, suggests process is PTH INDEPENDENT!

Check out this great review of diagnosis and management from the BMJ.


Diagnostic Approach to Hypercalcemia

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Management of Hypercalcemia

  1. IVF – restore intravasc volume, increase urine ca excretion
  2. Calcitonin – inhibit bone resorption, promote urinary excretion
  3. Bisphosphonates – block osteoclasts. Caution in renal disease.
  4. Loop diuretics – inc urinary excretion
  5. Glucocorticoids – useful in granulomatous dz or lymphoma
  6. Denosumab – inhibits RANKL (osteoclasts)
  7. Calcimimetics – reduces PTH – used on 2nd hyperparathyroidism in CKD
  8. Dialysis – low or no Ca dialysate

Adenosine deaminase (ADA) is a test that can be performed on pleural fluid to assess for tuberculosis.

Evernote: https://www.evernote.com/shard/s462/sh/1b39dfde-c9ef-404d-b4f4-e718ac004e27/fd5eb94469d66a8767eab14cd5435c68

 

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