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Hypercalcaemia — SCE Medical Oncology MCQ

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HardOncological EmergenciesHypercalcaemiaSCE Medical Oncology

A patient with newly diagnosed lymphoma has corrected calcium 3.18 mmol/L. PTH and PTHrP are suppressed, 25-hydroxyvitamin D is normal and 1,25-dihydroxyvitamin D is markedly elevated. Calcium remains high after intravenous saline. Which disease-specific treatment is most appropriate?

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Correct answer: D — Start a glucocorticoid to suppress calcitriol production while treating the lymphoma

Suppressed PTH/PTHrP with elevated calcitriol identifies calcitriol-mediated hypercalcaemia, classically seen in lymphoma. Glucocorticoids inhibit extrarenal calcitriol production and are the mechanism-directed treatment after rehydration. Cinacalcet treats PTH-driven disease; calcium/calcitriol would worsen the abnormality.

Reference: Society for Endocrinology emergency guidance: acute hypercalcaemia (Published February 2017): https://pmc.ncbi.nlm.nih.gov/articles/PMC5314807/