Department of Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
Department of Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA.
BMJ Case Rep. 2020 Apr 28;13(4):e233665. doi: 10.1136/bcr-2019-233665.
A 40-year-old man, with a history of metastatic parathyroid carcinoma, status post primary tumour resection and lung metastasectomy, was hospitalised for persistent severe hypercalcaemia and elevated parathyroid hormone levels despite conventional management and escalating doses of cinacalcet. A single dose (120 mg) of denosumab was given and his calcium level plummeted from 14.8 mg/dL to 5.5 mg/dL. After second lung metastasectomy, he developed prolonged hypocalcaemia that required calcium and vitamin D supplements for more than 3 years. In patients with severe hypercalcaemia refractory to conventional therapies, denosumab has been used off-label with some success. A known side effect of denosumab is hypocalcaemia, which is often short-lived. The risk of prolonged hypocalcaemia should be fully evaluated before using denosumab preoperatively, especially in patients with renal insufficiency, prolonged hyperparathyroidism or anticipated tumour debulking surgery.
一位 40 岁男性，患有甲状旁腺癌转移病史，曾行原发性肿瘤切除术和肺转移瘤切除术，因持续性严重高钙血症和甲状旁腺激素水平升高而住院，尽管进行了常规治疗和 cinacalcet 剂量递增治疗。给予单次剂量（120mg）地舒单抗后，血钙水平从 14.8mg/dL 骤降至 5.5mg/dL。第二次肺转移瘤切除术后，他出现长时间的低钙血症，需要钙和维生素 D 补充剂治疗超过 3 年。在对常规治疗反应不佳的严重高钙血症患者中，地舒单抗已被超适应证使用，并取得了一定的疗效。地舒单抗的已知副作用之一是低钙血症，通常是短暂的。在术前使用地舒单抗之前，应充分评估长时间低钙血症的风险，特别是在肾功能不全、甲状旁腺激素持续升高或预期进行肿瘤减瘤手术的患者中。
