{"entity":{"id":"hypercalcaemia-of-malignancy","kind":"term","name":"Hypercalcaemia of malignancy","aka":["Hypercalcemia of malignancy","HCM","Malignant hypercalcaemia","High calcium in cancer","Humoral hypercalcaemia of malignancy"],"tldr":"Some cancers raise the calcium level in the blood, either by releasing a hormone-like protein or by breaking down bone. High calcium causes thirst, passing a lot of urine, constipation, sickness and confusion. It is treated with fluids through a drip and bone-protecting drugs.","summary":"The Endocrine Society guideline (2023) calls hypercalcaemia of malignancy the most common metabolic complication of malignancies and notes that its incidence may be declining with more effective cancer treatment. It recommends (strong recommendation) denosumab or an intravenous bisphosphonate, suggests denosumab over a bisphosphonate, and for severe hypercalcaemia suggests calcitonin with a bisphosphonate or denosumab as initial treatment; treating the cancer itself is described as instrumental to control and prevent recurrence.\n\nThe Society for Endocrinology emergency guidance grades severity by calcium adjusted for albumin: below 3.0 mmol/L often without symptoms, 3.0 to 3.5 mmol/L usually needing prompt treatment, and above 3.5 mmol/L needing urgent correction because of the risk of dysrhythmia and coma. High calcium with a low PTH points to malignancy. Reviews describe two main mechanisms, secretion of PTH-related protein by the tumour (humoral hypercalcaemia, about 80% of cases) and bone destruction by osteolytic metastases (about 20%), with calcitriol-mediated cases in lymphoma. Multiple myeloma has the highest prevalence among cancers, breast and renal carcinomas and squamous cell carcinomas of any organ are the commonest solid-tumour causes, and breast cancer and myeloma account for most osteolytic cases.","asOf":"2026-11-11","links":[{"label":"Treatment of Hypercalcemia of Malignancy in Adults: An Endocrine Society Clinical Practice Guideline (J Clin Endocrinol Metab 2023)","url":"https://europepmc.org/article/MED/36545746"},{"label":"Walsh et al., Society for Endocrinology Endocrine Emergency Guidance: emergency management of acute hypercalcaemia in adult patients (Endocr Connect 2016)","url":"https://europepmc.org/article/PMC/PMC5314807"},{"label":"Sternlicht and Glezerman, Hypercalcemia of malignancy and new treatment options (Ther Clin Risk Manag 2015)","url":"https://europepmc.org/article/PMC/PMC4675637"},{"label":"Mirrakhimov, Hypercalcemia of malignancy: an update on pathogenesis and management (N Am J Med Sci 2015)","url":"https://europepmc.org/article/PMC/PMC4683803"}],"tags":["supportive-care-gaps-2026-11"],"related":[],"cancers":["breast-cancer","multiple-myeloma","lung-squamous-cell-carcinoma"],"sections":[],"technologies":["bone-modifying-agents"],"targets":[],"drugs":["denosumab","zoledronic-acid"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"provenance":{"editedBy":"OnCo supportive care gap fill (CDC, NHSN, SHEA, Society for Endocrinology, ESMO, MASCC, ASCO, ASTCT, NCI PDQ, Europe PMC)","editedOn":"2026-11-11"},"category":"Side effects"},"route":"/terms/hypercalcaemia-of-malignancy/","neighbours":{"cancer":[{"id":"breast-cancer","kind":"cancer","name":"Breast cancer (all types)","route":"/cancers/breast-cancer/"},{"id":"multiple-myeloma","kind":"cancer","name":"Multiple myeloma","route":"/cancers/multiple-myeloma/"},{"id":"lung-squamous-cell-carcinoma","kind":"cancer","name":"Squamous cell carcinoma of the lung","route":"/cancers/lung-squamous-cell-carcinoma/"}],"technology":[{"id":"bone-modifying-agents","kind":"technology","name":"Bone-modifying agents (bisphosphonates, denosumab)","route":"/technologies/bone-modifying-agents/"}],"drug":[{"id":"denosumab","kind":"drug","name":"Denosumab","route":"/drugs/denosumab/"},{"id":"zoledronic-acid","kind":"drug","name":"Zoledronic acid","route":"/drugs/zoledronic-acid/"}]}}