Endocrine Abstracts

Hypercalcaemia is a moderately common condition accounting for approximately 1% of all acute general medical presentations. Guidance on emergency management of the hypercalcaemic patient, aimed primarily at the generalist and at guiding initial stages of management has recently been developed by the society (https://www.endocrinology.org/policy/docs/13-02_EmergencyGuidance-AcuteHypercalcaemia.pdf). Indeed, management of hypercalcaemia is often relatively straight forward and based on adequate rehydration, identification of the cause and appropriate onward management depending on the underlying diagnosis. However, for a variety of reasons management can sometimes become extremely challenging. In this presentation I will briefly summarise the potential causes of a case of hypercalcaemia becoming refractory and outline a structured approach to the management of such cases of hypercalcaemia. I will discuss the role of less common but sometimes essential interventions such as emergency parathyroidectomy, dialysis, use of Denosumab as a hypocalcaemic agent and others. I will also share some “tricks of the trade” and give advice on when and when not to use these as well as outlining pitfalls that may sometimes cause problems. My aim is that by the end of this session you will have a better understanding of the causes of refractory hypercalcaemia, a structured approach to dealing with a case of refractory hypercalcaemia and more confidence in your approach to these cases.