Severe Hypercalcemia Followed by Profound Hypocalcemia in a Patient With Familial Hypocalcemia and Metastatic Cancer
- 1SUNY Downstate Health Science University, Brooklyn, New York
- 2Division of Endocrinology, Department of Medicine, Maimonides Medical Center, Brooklyn, New York
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.
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BibTeX
@article{zavgorodneva2026severe,
title = {{Severe Hypercalcemia Followed by Profound Hypocalcemia in a Patient With Familial Hypocalcemia and Metastatic Cancer}},
author = {Zhanna Zavgorodneva and Jocelyne Karam},
journal = {AACE Endocrinology and Diabetes},
year = {2026},
month = jun,
doi = {10.1016/j.aed.2026.06.001},
url = {https://doi.org/10.1016/j.aed.2026.06.001},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Severe Hypercalcemia Followed by Profound Hypocalcemia in a Patient With Familial Hypocalcemia and Metastatic Cancer
AU - Zhanna Zavgorodneva
AU - Jocelyne Karam
PY - 2026
DA - 2026/06/08
JO - AACE Endocrinology and Diabetes
DO - 10.1016/j.aed.2026.06.001
UR - https://doi.org/10.1016/j.aed.2026.06.001
AB - 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.
SN - 3050-9157
ER -