Extreme Hypercalcemia of Malignancy in a Pediatric Patient: Therapeutic Considerations

ABSTRACT Objective: Hypercalcemia of malignancy is rarely seen in children, and therefore few cases are available to illustrate the potential severity of presentation and clinical course. The objective of this report is to present the case of a pediatric patient with extreme hypercalcemia of malignancy and his successful management. Methods: We describe the therapeutic course of a pediatric patient with one of the highest calcium levels (21.4 mg/dL) reported in the literature and provide a review of what is published on pediatric hypercalcemia of malignancy, focusing on aspects of management. Results: Our patient's severe hypercalcemia rapidly responded to aggressive normal saline hydration, calcitonin, and zoledronic acid but was followed by hypocalcemia and hypophosphatemia, which were treated with oral supplementation. Conclusion: This case and review of the literature illustrate the potential severity of hypercalcemia of malignancy and important therapeutic considerations for practitioners. Abbreviations: PTH parathyroid hormone