Refractory Hypercalcemia of malignancy

Refractory Hypercalcemia of Malignancy

Hypercalcemia of malignancy (HCM) is a common complication of malignancies, in which calcium levels in the blood rise due to tissue damage, bone disease, untreatable tumors, and excessive production of active hormones. Refractory HCM is a more severe type of HCM caused by treatments normally used to manage the original disease.

Refractory HCM is a complex condition that can result from the malignancy itself, the treatment of the malignancy, or a combination of both. It is estimated that approximately 10-20% of all hypercalcemia cases are refractory, making this a common occurrence in cancer patients. Unfortunately, there is no reliable method for predicting which malignancies are more likely to develop refractory hypercalcemia.


Symptoms of HCM can include:

  • Frequent urination
  • Thirst and dehydration
  • Nausea, vomiting
  • Loss of appetite
  • Bone and joint pains
  • Fatigue
  • Confusion or disorientation
  • Kidney stones


Sometimes, refractory HCM can be treated with drugs that reduce the level of calcium in the blood. These include bisphosphonates, calcitonin, and corticosteroids.

More severe cases may require surgery to remove tumors or to repair problems with the bones or parathyroid glands. In some cases, radiation therapy or chemotherapy may also be used to reduce the amount of tumor-producing hormones in the body.

In refractory cases, doctors may also explore additional treatments, such as immunotherapy or stem cell transplants. There is no one-size-fits-all treatment for HCM, so it is important that each patient works closely with their healthcare team to develop a plan that best meets their needs and maintains their overall health.