SFEBES2023 Poster Presentations Bone and Calcium (41 abstracts)
Resistant hypocalcaemia in a patient with prostatic adenocarcinoma with extensive osteoblastic metastasis
Saroj Sahoo , Eleni Armeni , Pierre Bouloux , Ashley Grossman , Quazi Islam , Eftimia Karra , Bernard Khoo , Ammara Naeem , Muna Nwokolo , Dipesh Patel , Kalyan Shekhda , Clare Silverwood & Ahmed Yousseif
Royal Free Hospital, London, United Kingdom
Introduction: Hypocalcaemia is rare in patients with malignancy, occurring in <2% of patients with malignancy. Osteoblastic bone metastases as an aetiology of hypocalcaemia are further rare.
Case description: A 75-year-old male presented to emergency with back pain, and immobility. He was diagnosed to have prostate cancer in 2019. A bone scan in April 2022 showed extensive sclerotic metastases involving axial and proximal appendicular skeleton. His treatment included antiandrogens, goserelin, palliative chemotherapy, and diethylstilboestrol. He had received a session of palliative radiotherapy to spine two months prior. CT and MRI scans of spine revealed progressive sclerotic metastases. His biochemistry revealed presence of new-onset hypocalcaemia (corrected calcium 1.75 mmol/l, and ionised calcium 0.94 mmol/l), and hypophosphatemia (0.85 mmol/l). Serum levels of vitamin D (51 nmol/l) and magnesium (0.75 mmol/l) were normal. His parathyroid hormone was elevated (16.4 pmol/l). 24-h urinary calcium was inappropriately low (3.0 mmol). He was treated with intravenous calcium infusion, along with oral calcium, vitamin D, and alfacalcidol supplements. During the hospital stay, he needed intravenous magnesium infusion and oral phosphorous supplements. Despite prolonged intravenous calcium replacement and higher doses of oral alfacalcidol (up to 8 mg/day) and elemental calcium (up to 4800 mg/day) replacement, he had persistent hypocalcaemia with calcium levels ranging from 1.70 to 1.87 mmol/l. Considering his debilitating condition and lack of any systemic therapy to treat the underlying condition, a plan for palliation was considered.
Discussion: Hypocalcaemia secondary to osteoblastic metastases is most commonly seen in background of prostate cancer. It can be life threatening and challenging to manage. Increased influx of calcium and phosphate into the sclerotic bone has been hypothesised to cause hypocalcaemia. Care should be taken to monitor serum calcium in patients with malignancy and rule out other aetiologies of hypocalcaemia when present.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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