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

## TL;DR

This paper presents a case where denosumab effectively managed severe hypercalcemia in a patient with primary hyperparathyroidism when other treatments failed.

## Contribution

The paper adds a real-world clinical case to the limited evidence on using denosumab for hypercalcemia in primary hyperparathyroidism.

## Key findings

- Denosumab stabilized calcium levels in a patient with treatment-resistant hypercalcemia.
- The patient's renal function improved after denosumab treatment.
- Denosumab can be a preoperative or alternative treatment when surgery is not possible.

## 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.