HealthDay News — In a clinical practice guideline issued by the Endocrine Society and published online December 21 in the Journal of Clinical Endocrinology & Metabolism, recommendations are presented for the treatment of hypercalcemia of malignancy (HCM) in adults.

Ghada El-Hajj Fuleihan, MD, MPH, from the American University of Beirut in Lebanon, and colleagues developed guidelines for treatment of adults with HCM. Eight clinical questions relating to treatment of HCM in adult patients were identified and prioritized.

The authors strongly recommend treatment with denosumab (Dmab) or an intravenous (IV) bisphosphonate (BP) for adults with HCM. Based on low-certainty evidence, the panel conditionally recommended use of Dmab rather than IV BP for adults with HCM, a combination of calcitonin and an IV BP or Dmab as initial treatment, and use of Dmab in adults with refractory/recurrent HCM despite BP treatment. The addition of an IV BP or Dmab is suggested for adults with hypercalcemia due to tumors associated with high calcitrol levels who are already receiving glucocorticoid therapy but continue to have severe or symptomatic HCM. For adults with hypercalcemia due to parathyroid carcinoma, treatment with either a calcimimetic or an antiresorptive (IV BP or Dmab) is suggested.

“Health care providers currently have few evidence-based recommendations for which medications to use to treat HCM,” El-Hajj Fuleihan said in a statement. “Our guideline followed a rigorous process to examine the evidence available to date, and provides a clinical care workflow based on the severity and pathophysiology of HCM, taking into account contextual factors.”

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