Unraveling the Mysteries of Hypercalcemic Encephalopathy: A Clinical Experience from A Tertiary Care Center.
Abstract
Manjeet Goyal, Saurabh Arora, Diljot Singh, Naveen Mittal, Karan Chouhan, Neelesh Sharma, Shubam Trehan, Supraja Srikanth, Namit Mittal and Khushi Goyal
Background Hypercalcemic encephalopathy is a rare but clinically significant condition characterized by a range of complex symptoms due to elevated serum calcium levels. The causes of this condition can stem from various underlying factors, with the most common being primary hyperparathyroidism, malignancies, and granulomatous diseases. This study aims to provide a comprehensive clinical profile of hypercalcemic encephalopathy by examining a cohort of patients presenting at a tertiary care center.
Results We analyzed etiologies, clinical manifestations, and short-term outcomes in 32 patients with a mean age of 32.45 years. The study revealed that malignancy-related hypercalcemia was the predominant cause in a significant portion of the cases (46.8%), indicating that cancer-associated mechanisms play a substantial role in the development of hypercalcemic encephalopathy. Hyperparathyroidism, accounted for 34.3% of the cases, followed by granulomatous disease, which was the underlying factor in 12.5% of the cases. Unfortunately, six patients experienced mortality during the study. The primary reasons for these unfortunate outcomes were related to hypercalcemia itself, highlighting critical importance of its proper management.
Conclusion The treatment responses observed in the study provided valuable insights. About 37.5% of the patients responded positively to the administration of intravenous fluids and calcitonin, a hormone involved in calcium regulation. However, for those who did not respond to these standard treatments, the introduction of denosumab, a medication that inhibits bone resorption and can lower calcium levels, yielded positive outcomes. This suggests the potential utility of denosumab in cases where traditional treatments are ineffective.
Overall, this study significantly contributes to our understanding of hypercalcemic encephalopathy by delving into its clinical features, the range of underlying causes, responses to treatment, and patient outcomes. The findings underscore the importance of recognizing this condition promptly and implementing tailored interventions to ensure optimal management and improved patient care