P57 | Use of denosumab in a complicated hypercalcemic crisis

D. D’Ambrosio, V. Vatiero, S. Damiano, A. Petrillo, F. Ievoli | UOC Medicina Generale, PO Aversa, ASL Caserta, Italy

Premises: Parathyroid carcinoma (PC) is a rare entity in primary hyperparathyroidism. A persistent hypercalcemia following complete resection of a primary parathyroid carcinoma can be related to bone metastasis. Hypercalcemic crisis can lead to recurrent acute pancreatitis. Denosumab is a fully human, monoclonal, synthetic, IgG2 antibody that binds to RANKL and inhibits formation, function, and survival of activated osteoclasts, bone destruction and tumour growth. Its use is raccomended at the bone metastases diagnosis.
Description of the Case report: A 74-year-old caucasian male with a history of partial thyroidectomy for PC one year ago and subsequent finding of bone metastases presented to our ward for drowsiness with laboratory evidence of severe hypercalcemia, hyperparathyroidism, acute kidney injury (AKI) and pancreatitis. CT showed an inhomogeneous pancreas with periglandular fluid and widespread structural bone alterations due to metastasis. He began forced hydrating support, diuretics and steroids and we decided to administer denosumab 120 mg sc, with rapid clinical improvement (creatinine was reported from 3.9 to 1.9 mg/dl, lipase from 1239 to 111 mg/dl and calcemia from 19,2 to 11,25 mg/dl).
Conclusions: This case shows a combination of complicated events (hypercalcemic crisis due to bone metastasis of PC with acute pancreatitis and AKI). The use of denosumab for the resolution of the hypercalcemia is advised to its greater ease of handling and superiority compared to zoledronic acid without the need for dose adjustment for renal dysfunction or kidney monitoring.