Moderate-to-severe hypercalcemia secondary to primary hyperparathyroidism refractory to conventional treatment (therapeutic management with denosumab): case report and literature review

Abstract

Severe hypercalcemia resistant to conventional medical treatment is a rare complication of primary hyperparathyroidism, and published information on the use of denosumab in patients with this condition is limited. This article aims to review the current literature on the utility of denosumab as a hypocalcemic agent in the context of a real clinical case. We present the case of an 87-year-old woman with nonspecific symptoms of constipation and asthenia who was diagnosed with severe hypercalcemia secondary to primary hyperparathyroidism. Treatment with cinacalcet, bisphosphonates, and hydration was ineffective, so denosumab was used until surgery. Denosumab stabilized calcium levels, improved renal function, and alleviated the patient's symptoms. Our study highlights that denosumab is a useful tool in managing hypercalcemia associated with primary hyperparathyroidism, either as a preoperative measure or when surgery is contraindicated.