HYPERCALCEMIC SYNDROME ASSOCIATED WITH ANDROGENIC AND ESTROGENIC THERAPY

Abstract

Androgenic and estrogenic hormones have been found of value in the treatment of advanced breast carcinoma. Some patients in the course of treatment develop toxic reactions, associated with hypercalcemia and signs and symptoms of renal insufficiency. Four such patients, 3 with osteolytic lesions secondary to mammary cancer and 1 with osteolytic lesions of a reticulum-cell sarcoma, are reported. Withdrawal of the hormones and paren-teral admn. of saline, glucose and 2.5% Na citrate, the latter in 250 ml. quantities, corrected the toxemia. Reinstitution of hormonal therapy frequently produced a lethal outcome. Postmortem examination of all cases revealed nephrocalcinosis. Pre-existent renal damage, immobilization and cachexia are factors which may contribute to the production of hypercalcemia. Patients with pre-treatment hypercalcemia preferably should not receive hormonal therapy. Bedridden patients or those with markedly impaired renal function should be treated cautiously. Frequent blood-chemical and kidney-function studies should be performed and adequate fluid intake maintained at all times. Listlessness, nausea, vomiting and an increase in serum Ca or evidence of progressive renal impairment should be a warning to abandon the hormonal therapy.