. A 70-year old male has been experiencing intermittent epistaxis, fatigue and pain in bones for the past 4 months. Laboratory investigations are as follows : Serum Ca”: 1F2 mg/dL (Normal 8.9-10*1mg/dL) The above condition is to be treated with –
**Core Concept**
Hypercalcemia of malignancy is a condition characterized by elevated serum calcium levels due to the secretion of parathyroid hormone-related protein (PTHrP) or other factors by cancer cells, leading to increased bone resorption and renal calcium reabsorption.
**Why the Correct Answer is Right**
The patient's symptoms and laboratory findings are consistent with hypercalcemia of malignancy, a common complication of cancer. The elevated serum calcium level is likely due to the secretion of PTHrP by the cancer cells, which mimics the action of parathyroid hormone (PTH) and stimulates bone resorption and renal calcium reabsorption. Treatment of hypercalcemia of malignancy typically involves hydration, bisphosphonates, and in some cases, glucocorticoids or calcitonin.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because hydration alone is not sufficient to treat hypercalcemia of malignancy, as it only addresses volume status and does not directly affect bone resorption or renal calcium reabsorption.
**Option B:** This option is incorrect because glucocorticoids are not the first-line treatment for hypercalcemia of malignancy, although they may be used in certain cases.
**Option C:** This option is incorrect because calcitonin is not the primary treatment for hypercalcemia of malignancy, although it may be used in some cases to rapidly lower calcium levels.
**Clinical Pearl / High-Yield Fact**
In patients with hypercalcemia of malignancy, it's essential to identify the underlying cancer and treat it aggressively, as the prognosis is often poor and the condition can be refractory to medical management.
**Correct Answer: D. Bisphosphonates. Bisphosphonates are the mainstay of treatment for hypercalcemia of malignancy, as they inhibit bone resorption and reduce serum calcium levels.**