Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2022) 86 P189 | DOI: 10.1530/endoabs.86.P189

SFEBES2022 Poster Presentations Bone and Calcium (40 abstracts)

Denosumab induced recurrent, prolonged and life threatening hypocalcaemia

Muhammad Tahir Chohan 1 , Japhet Olaremi 2 , Dr So Pye 1 & Dr Sony Anthony 1

1University Hospital North Tees, Stockton-On-Tees, United Kingdom; 2Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom

Introduction: Denosumab, a human monoclonal antibody used in osteoporosis and second line treatment option for hypercalcaemia, can cause profound hypocalcaemia especially in Vitamin-D depleted and cancer patients.

Case history: 56 years female, with diabetes, hypertension on metformin, empagliflozin, amlodipine and ramipril, presented with 3 months history of backache, no red flag signs, clinically and hemodynamically stable except mild confusion and spinal tenderness but no other neurological deficit. Bloods showed hypercalcaemia with suppressed Parathyroid Hormone (PTH) and acute kidney injury (AKI) stage 3. X-ray spine showed possible wedge fracture and subsequent investigation confirmed spinal metastasis secondary to breast cancer. Hypercalcemia management with Denosumab led to severe hypocalcaemia within 14 days which was recurrent, requiring prolonged intravenous calcium infusions.

Investigations: Initial bloods: Urea: 32 (2.5-7.8 mmol/l), Creatinine: 382 (49-90umol/l), Corrected Calcium: 4.08 (2.20-2.60 mmol/l), PTH: 0.8 (1.3-7.3 pmol/l), Phosphate: 2.26 (0.8-1.5 mmol/l), Magnesium: 0.78 (0.7-1.0 mmol/l), Vitamin-D levels weren’t checked pre-Denosumab but 2 weeks later were 31 (>50 nmol/l). Bloods 1 month after Denosumab: Corrected Calcium: 1.58 (2.20-2.60 mmol/l), Phosphate: 1.45(0.8-1.5 mmol/l), Magnesium: 0.66 (0.7-1.0 mmol/l), 25OH-vitamin-D (post-replacement): 106 (>50 nmol/l). Full blood count, liver, thyroid, lipid, coagulation profile was normal. CT spine showed bone metastasis and pathological rib fractures. Biopsy of breast mass confirmed ductal carcinoma in situ.

Treatment: Given AKI, hypercalcaemia and bone metastasis she was treated with intravenous fluids (IVT) and Denosumab 120 mg subcutaneously which resulted in profound, recurrent, symptomatic hypocalcaemia with prolonged hospital stay (nearly 2 months) and frequent intravenous calcium infusions besides magnesium and Vitamin-D replacement. Calcium and Vitamin-D levels remained normal on high dose oral replacement on out-patient follow-up.

Conclusions: • IVT and bisphosphonates remains first line management for hypercalcemia unless contraindicated as per endocrine society guidelines.

• Vitamin-D must be replenished before giving Denosumab to prevent life threatening hypocalcaemia.

• Patient requires high dose vitamin-D and Calcium replacement post Denosumab to prevent hypocalcaemia and frequent monitoring.

Volume 86

Society for Endocrinology BES 2022

Harrogate, United Kingdom
14 Nov 2022 - 16 Nov 2022

Society for Endocrinology 

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