Hypercalcemia of Malignancy: An Update on Pathogenesis and Management.
Hypercalcemia of Malignancy: An Update on Pathogenesis and Management.
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DOI：
10.4103/1947-2714.170600
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发表时间：
2015-11
期刊：
影响因子：
--
通讯作者：
Mirrakhimov AE
中科院分区：
文献类型：
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作者：
Mirrakhimov AE
恶性肿瘤高钙血症是一种常见现象，通常见于晚期癌症患者。我们的目的是对恶性肿瘤相关高钙血症的病因、发病机制、临床表现和治疗进行最新综述。我们检索了 PubMed/Medline、Scopus、Embase 和 Web of Science，查找 1950 年至 2014 年 12 月发表的关注恶性肿瘤高钙血症的原始文章、病例报告和病例系列文章。恶性肿瘤高钙血症通常表现为钙水平明显升高，因此通常症状严重。几种主要机制导致恶性肿瘤高钙血症的发生，包括甲状旁腺激素相关肽介导的体液高钙血症、溶骨性转移相关的高钙血症、1,25维生素D介导的高钙血症以及甲状旁腺癌和其他患者的甲状旁腺激素介导的高钙血症。 甲状旁腺癌。诊断应包括病史、体格检查以及上述高钙血症介质的测定。治疗包括水合、降钙素、双磷酸盐、狄诺塞麦，以及某些患者的泼尼松和西那卡塞。患有晚期基础肾脏疾病和难治性严重高钙血症的患者应考虑进行血液透析。血液学或肿瘤学和姑息治疗专家应尽早参与，指导癌症靶向治疗的选择，并帮助患者及其家人讨论以舒适为导向的护理。
Hypercalcemia of malignancy is a common finding typically found in patients with advanced stage cancers. We aimed to provide an updated review on the etiology, pathogenesis, clinical presentation, and management of malignancy-related hypercalcemia. We searched PubMed/Medline, Scopus, Embase, and Web of Science for original articles, case reports, and case series articles focused on hypercalcemia of malignancy published from 1950 to December 2014. Hypercalcemia of malignancy usually presents with markedly elevated calcium levels and therefore, usually severely symptomatic. Several major mechanisms are responsible for the development of hypercalcemia of malignancy including parathyroid hormone-related peptide-mediated humoral hypercalcemia, osteolytic metastases-related hypercalcemia, 1,25 Vitamin D-mediated hypercalcemia, and parathyroid hormone-mediated hypercalcemia in patients with parathyroid carcinoma and extra parathyroid cancers. Diagnosis should include the history and physical examination as well as measurement of the above mediators of hypercalcemia. Management includes hydration, calcitonin, bisphosphonates, denosumab, and in certain patients, prednisone and cinacalcet. Patients with advanced underlying kidney disease and refractory severe hypercalcemia should be considered for hemodialysis. Hematology or oncology and palliative care specialists should be involved early to guide the options of cancer targeted therapies and help the patients and their closed ones with the discussion of comfort-oriented care.