What specific treatment can be used in the management of hypercalcemia?
Glucocorticoids are the first line of therapy for hypercalcemia-associated elevated 1,25D levels in sarcoidosis and have been successfully used in other cases of granulomatous hypercalcemia like tuberculosis, silicone-induced granulomas, etc. Oral calcium intake as low as 400 mg/day is also recommended in these cases (to limit its intestinal absorption).
For hypercalcemia of malignancy associated with bone resorption, bisphosphonates (pamidronate, zoledronic acid), which induce osteoclast apoptosis, are considered first line of therapy. The clinical response is apparent in a few days. Calcitonin inhibits osteoclast bone resorption within hours, but its use is limited by the modest effect and rapid development of tachyphylaxis. Denosumab, a monoclonal antibody that blocks osteoclast activation by targeting the receptor activator of NF-kB ligand, has been used in some case series of bisphosphonates-resistant hypercalcemia.
Cinacalcet activates the CaSR in the parathyroid gland, thus inhibiting PTH secretion; it may be used in patients with parathyroid cancer in whom surgical parathyroid resection is not curative.