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Severe Hypercalcemia Followed by Profound Hypocalcemia in a Patient With Familial Hypocalcemia and Metastatic Cancer

Year: 2026
Type: article
Study design: Case Report
Abstract: Background/Objective: Severe hypercalcemia is commonly associated with malignancy and, less frequently, with excessive calcium and vitamin D intake. Management is particularly challenging in patients with underlying disorders of calcium homeostasis. We present a case highlighting the complexities of treating hypercalcemia following discontinuation of denosumab in a patient with malignancy and underlying familial hypocalcemia on long-term calcium supplementation. Case Report: A 70-year-old woman with metastatic breast cancer and underlying familial hypocalcemia on chronic calcium and active vitamin D supplementation presented with hypercalcemic crisis following discontinuation of long-term denosumab therapy. She was treated with intravenous hydration and 2 doses of calcitonin, which led to a rapid decline in serum calcium levels and subsequent profound hypocalcemia requiring reinitiation of supplementation. Shortly after discharge, she was readmitted with recurrent hypercalcemia, again treated with 1 dose of calcitonin, followed by recurrent hypocalcemia. She was ultimately stabilized with careful titration of calcium and active vitamin D therapy. Discussion: This case highlights several important clinical considerations, including the patient's familial history, oncologic history, the underlying mechanisms contributing to abrupt shifts in calcium levels, and strategies for effective management. Conclusion: Treating hypercalcemia in patients with underlying hypocalcemia disorders can be challenging. Clinicians should take in consideration the complex pathophysiology of their disorder and monitor calcium closely to prevent hypocalcemia.
DOI: 10.1016/j.aed.2026.06.001
Language: English
Subfield: Nephrology
Field: Medicine
Open Access status: hybrid
OpenAlex ID: W7163888089
FWCI:
Cites: 13
Cited by:
Related to: 10