From the Department of Internal Medicine, William Beaumont Hospital.
Oakland University William Beaumont School of Medicine, Royal Oak, MI.
Pancreas. 2021 Feb 1;50(2):206-213. doi: 10.1097/MPA.0000000000001741.
Hypercalcemia of malignancy confers a poor prognosis. This systematic review evaluated published cases of hypercalcemia of malignancy presenting with acute pancreatitis (AP), in terms of clinical presentation and outcomes.
A comprehensive review of PubMed and Embase until March 18, 2020, was conducted. Studies were included if they reported on patients with hypercalcemia of malignancy and AP with attempts to exclude other etiologies of hypercalcemia and AP. Two independent reviewers selected and appraised studies using the Murad tool.
Thirty-seven cases were identified. Mean (standard deviation) age was 44.8 (2.46) years. Mean (standard deviation) presenting corrected calcium was 14.5 (0.46) mg/dL. Parathyroid carcinoma (21.6%) and multiple myeloma (21.6%) were the most common malignancies. Cases were classified as severe (37.8%), mild (21.6%), and moderately severe (18.9%), whereas 21.6% did not report severity. Necrotizing pancreatitis developed in 21.6% of cases. Most cases were treated with intravenous hydration and bisphosphonates or calcitonin/calcitonin analogues. Mortality was 32.4% during the same presentation of AP. Among mortality cases, 10 of 12 had severe AP, and 5 of 12 had necrotizing pancreatitis. Degree of hypercalcemia did not influence mortality.
Acute pancreatitis associated with hypercalcemia of malignancy is rare. One in 3 patients with this presentation may not survive AP.
恶性肿瘤相关性高钙血症预后不良。本系统评价评估了以急性胰腺炎（AP）为表现的恶性肿瘤相关性高钙血症的病例，从临床表现和结局方面进行评估。
对 PubMed 和 Embase 进行全面检索，检索截至 2020 年 3 月 18 日。纳入报道恶性肿瘤相关性高钙血症合并 AP 且尝试排除其他高钙血症和 AP 病因的病例研究。两位独立的审查员使用 Murad 工具选择和评价研究。
共纳入 37 例病例。平均（标准差）年龄为 44.8（2.46）岁。平均（标准差）校正血钙为 14.5（0.46）mg/dL。甲状旁腺癌（21.6%）和多发性骨髓瘤（21.6%）是最常见的恶性肿瘤。病例分为重度（37.8%）、轻度（21.6%）和中度重度（18.9%），而 21.6%未报告严重程度。21.6%的病例发生坏死性胰腺炎。大多数病例接受静脉补液和双膦酸盐或降钙素/降钙素类似物治疗。在同一 AP 发作期间，死亡率为 32.4%。在死亡病例中，10/12 例为重度 AP，5/12 例为坏死性胰腺炎。高钙血症的严重程度并不影响死亡率。
恶性肿瘤相关性高钙血症合并 AP 罕见。该表现患者中约 1/3 可能无法存活。
