Pamidronate and calcitonin as therapy of acute cancer-related hypercalcemia in children

Abstract.

Severe symptomatic hypercalcemia is a rare event in children with malignancies. Up to now there is limited experience treating childhood hypercalcemia with bisphosphonates in addition to calcitonin. We report a 5-year-old boy with acute lymphoblastic lymphoma who presented with malignant hypercalcemia at diagnosis. The maximal serum calcium concentration was 15.2 mg/dl (3.81 mmol/l). Conventional therapy with forced diuresis and furosemide failed. Calcitonin (10 IU/kg/24 h i.v. for 2 days) and pamidronate (1 mg/kg over 2 hours i.v.) were used successfully without adverse effect lowering the serum calcium level within 24 hours to normal values. We recommend the use of calcitonin and pamidronate as first-line therapy together with forced diuresis and furosemide in childhood hypercalcemia secondary to malignancies as it is rapidly effective and has no significant side effects.

Hyperkalzämie ist ein seltenes Ereignis bei Kindern mit malignen Erkrankungen. Bis jetzt gibt es nur wenig Erfahrung, eine Hyperkalzämie im Kindesalter mit Pamidronat zusätzlich zu Calcitonin zu behandeln. Wir berichten über einen 5-jährigen Jungen mit akuter lymphatischer Leukämie, der bei Diagnosestellung der malignen Erkrankung eine symptomatische Hyperkalzämie zeigte. Die maximale Kalziumkonzentration im Serum war 15,2 mg/dl (3,81 mmol/l). Konventionelle Therapie mit Wässerung und Furosemid zeigte keinen Erfolg. Durch den Einsatz von Calcitonin (10 E/kg/24 Stunden i.v. für 2 Tage) und Pamidronat (1 mg/kg in 2 Stunden i.v.) konnte der Kalziumspiegel innerhalb von 24 Stunden in Normbereiche gesenkt werden. Es traten keine schweren Nebenwirkungen auf. Wir empfehlen den primären Einsatz von Calcitonin und Pamidronat zusätzlich zu forcierter Diurese und Furosemid bei Kindern mit symptomatischer Hyperkalzämie bedingt durch eine Krebserkrankung.

Key words:

Cancer-related hypercalcemia - childhood - pamidronate - calcitonin

Schlüsselwörter:

Hyperkalzämie durch maligne Erkrankun-gen - Kinder - Pamidronat - Calcitonin

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