SHM Converge Scientific Abstract ePoster Gallery-Bisphosphonate Therapy for Refractory Hypercalcemia of Malignancy in Pregnancy

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This case report describes a 30-year-old pregnant woman at 18 weeks’ gestation with metastatic ER/PR-positive mucinous breast cancer who presented with severe symptomatic hypercalcemia (calcium 15.2 mg/dL, ionized calcium 2.1) causing nausea, vomiting, constipation, urinary frequency, lethargy, and tachycardia. Imaging showed extensive progression of metastatic disease involving lymph nodes, liver, and bone.<br /><br />Her hypercalcemia was refractory to standard treatment with aggressive IV fluids, calcitonin, continuous renal replacement therapy, and later hemodialysis. Paclitaxel was started for cancer control, but it did not meaningfully improve calcium levels. After multidisciplinary discussion and review of the limited literature on bisphosphonate use in pregnancy, the patient agreed to receive pamidronate on three occasions. Following bisphosphonate therapy, her calcium levels improved, allowing dialysis to be paused when ionized calcium fell below 1.8.<br /><br />Later in the pregnancy, she developed pre-eclampsia and delivered a 1.29 kg male infant at 29 weeks and 6 days gestation. No apparent fetal adverse effects were attributed to pamidronate exposure at 21 weeks 6 days gestation. The patient’s cancer is now stable on letrozole and abemaciclib, and the infant is otherwise doing well aside from requiring a gastrostomy tube for an unclear reason.<br /><br />The authors emphasize that bisphosphonate use in pregnancy remains poorly studied, especially for hypercalcemia of malignancy. Concerns include potential fetal skeletal abnormalities and uncertain placental transfer. This case suggests that, when hypercalcemia is severe and refractory, pamidronate may be a reasonable option after careful shared decision-making, but more evidence is needed to define fetal safety by gestational age.

Asset Subtitle

Erica Lavey

Meta Tag

Author List Alice Chedid, Erica Lavey, Jerry Rodgers, Michael VanDillen, Molly Houser, Nathaniel Rogers

Category Clinical Vignettes

Concept Hypercalcemia of Malignancy

Concept Pregnancy

Concept Maternal Stabilization

Concept Fetal Safety

Concept Intravenous Fluids

Distinguished Non-Finalist

Presenter Organization The University of Tennessee Health Science Center

Presenting Author Erica Lavey

Track Adult

Keywords

pregnancy

metastatic breast cancer

hypercalcemia

pamidronate

bisphosphonate

fetal safety

pre-eclampsia

dialysis

mucinous carcinoma

shared decision-making

Hypercalcemia of Malignancy

Pregnancy

Maternal Stabilization

Fetal Safety

Intravenous Fluids