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Mammogram radio imaging for breast cancer diagnosis. ©Shutterstock

Hypocalcaemia affects around 10% of individuals with advanced cancer, usually caused by malabsorption, metastatic disease or treatment with bone anti-resorptive drugs. The prognosis is usually better than hypercalcaemia.

Darawshi et al. present the case of a 45-year-old woman with previously treated (left mastectomy, adjuvant chemotherapy and tamoxifen) metastatic breast cancer (T4b N0 M0 grade 2, oestrogen receptor-positive, progesterone receptor-negative and Ki-67=2%), who developed treatment-resistant hypocalcaemia. She had profound hypocalcaemia on admission (1.52mmol/l) with non-elevated parathyroid hormone (3.8pmol/l, reference range 1.6–6.8) and low 25-hydroxyvitamin D3 (27nmol/l). She was treated with i.v. calcium gluconate 10% and oral calcium carbonate (total average daily dose 11.2g). Her calcium remained low until she was treated with chlorambucil and leuprolide for a recurrence of her breast cancer confirmed on bone biopsy.

The case highlights the difficulties in managing individuals with calcium derangement in the context of cancer. However, it highlights that severe hypocalcaemia can sometimes be a presenting issue for metastatic recurrence.

Read the full article in Endocrinology, Diabetes & Metabolism Case Reports 2022 20-0222 https://doi.org/10.1530/EDM-20-0222