Publication Date

5-2025

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Abstract

Objective: To describe the presentation, management, and outcomes of severe hypercalcemia in two adolescent females secondary to ovarian malignancy. Methods: The case series includes two adolescent female patients, aged 11 and 16, diagnosed with rare ovarian malignancies and associated hypercalcemia. The 11-year-old female was diagnosed with small cell carcinoma of ovary while the 16-year-old was diagnosed with dysgerminoma. Both patients presented with abdominal pain, nausea and constipation. The 11-year-old received zoledronic acid while the 16-year-old received pamidronate. Serum calcium level, symptoms and adverse effects were monitored before and after both medications. Results: Both patients presented with severe hypercalcemia. The 11-year old presented with serum calcium of 15.0 mg/dL while the 16-year old presented with a serum calcium of 15.9 mg/dL. Both patients were refractory to hyperhydration with isotonic normal saline and 3 or more doses of calcitonin over a span of 3 days. Patients were then given bisphosphonates to decrease severe hypercalcemia. Patient 1 received one dose of zoledronic acid 0.1 Unit/kg while patient 2 received pamidronate. Calcium decreased to 10.4 mg/dl in 56 hours after zoledronic acid administration. Patient also had her tumor resection 3 days after medication administration which further decreased serum calcium to a lowest of 6.9 mg/dl. This was improved after 1 dose of intravenous calcium gluconate. Patient 2 received 1 dose of pamidronate 0.37 mg/kg. Serum calcium decreased to 9.1 mg/dl in 41 hours. Patient had surgical debulking surgery the same day. Lowest post operative calcium level for patient 2 was 7.5 mg/dl 3 days post pamidronate and 1 day post tumor debulking. Diagnosis was confirmed by pathology to be small cell carcinoma of ovary-hypercalcemia type and dysgerminoma respectively for patient 1 and 2. Patient 1 required calcium supplementation for 5 days post-surgery while patient 2 needed no calcium supplementation. No adverse effects noted on both patients. Conclusion: Small cell carcinoma of ovary and dysgerminoma are rare causes of hypercalcemia in adolescents. These cases highlight the importance of recognizing paraneoplastic hypercalcemia, safety, efficacy, and monitoring for hypocalcemia after a single dose of bisphosphonate. Close monitoring is needed if patients plan to undergo tumor resection within the next week as both medications are known to have a long half-life.

Disciplines

Endocrinology, Diabetes, and Metabolism | Pediatrics

Notes

Presented at the Pediatric Endocrine Society (PES) 2025 Annual Meeting; National Harbor, MD; May 15-18, 2025.

Bisphosphonate Treatment in Pediatric Patients with Rare Ovarian Malignancy and Hypercalcemia: A Case Series

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