Eshak Nouran, Abdelnabi Mahmoud, Benjanuwattra Juthipong, Ismail Amr, Leelaviwat Natnicha, Elharabi Zeyad, Culberson John
Geriatric Division, Family Medicine Department, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.
Internal Medicine Department, Texas Tech University Health Sciences Center, Lubbock, Texas.
Eur J Case Rep Intern Med. 2022 Dec 23;9(12):003706. doi: 10.12890/2022_003706. eCollection 2022.
Denosumab is one of the most commonly used antiresorptive drugs for osteoporosis treatment and the prevention of skeletal-related events in cancer patients. The purpose of this case report is to highlight potentially life-threatening severe hypocalcaemia as a side effect of denosumab complicated by refractory shock that failed to respond to medical management including intravenous calcium, vasopressors and inotropes in an elderly man with a history of prostatic cancer.
Denosumab is a commonly used antiresorptive drugs for the treatment of osteoporosis and to prevent skeletal-related events in patients with cancer.A common side effect of denosumab is hypocalcaemia; conditions associated with a higher risk of hypocalcaemia include chronic kidney disease, pre-existing hypocalcaemia, and metastatic cancer.Severe hypocalcaemia may induce cardiovascular manifestations such as hypotension, bradycardia, impaired cardiac contractility, impaired vascular tone, and arrhythmias.Shock results from diminished vascular smooth muscle tone and tends to occur with rapid severe hypocalcaemia; it is usually refractory to fluid and pressor therapy until hypocalcaemia is corrected.
地诺单抗是治疗骨质疏松症和预防癌症患者骨骼相关事件最常用的抗吸收药物之一。本病例报告的目的是强调在一名有前列腺癌病史的老年男性中，地诺单抗作为一种副作用可能导致危及生命的严重低钙血症，并伴有难治性休克，对包括静脉补钙、血管加压药和正性肌力药在内的药物治疗无反应。
地诺单抗是治疗骨质疏松症和预防癌症患者骨骼相关事件常用的抗吸收药物。地诺单抗的常见副作用是低钙血症；与低钙血症风险较高相关的情况包括慢性肾病、既往存在的低钙血症和转移性癌症。严重低钙血症可能诱发心血管表现，如低血压、心动过缓、心脏收缩力受损、血管张力受损和心律失常。休克是由血管平滑肌张力降低引起的，往往发生在快速严重低钙血症时；在低钙血症得到纠正之前，它通常对液体和升压治疗无效。
