Presenter Status
Fellow
Abstract Type
Case report
Primary Mentor
Dr. Jennifer Boyd
Start Date
12-5-2025 11:30 AM
End Date
12-5-2025 1:30 PM
Presentation Type
Poster Presentation
Description
Objectives
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. 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 levels, symptoms and medication side effects were monitored before and after bisphosphonate therapy.
Results
Both girls presented with severe hypercalcemia. Patient 1 was an 11-year old girl who presented with serum calcium of 15.0 mg/dL. She began hyperhydration with isotonic normal saline and calcitonin. Serum calcium transiently decreased to 11.7 mg/dL after the first dose of calcitonin and 24 hours after hyperhydration. However, it increased to its highest peak of 14.1 mg/dL despite hyperhydration and 4 doses of calcitonin over a span of 4 days. Therefore, she received one dose of zoledronic acid 0.1 Unit/kg. Calcium decreased to 10.4 mg/dl in 56 hours after zoledronic acid administration. She underwent tumor resection 3 days after medication administration which further decreased serum calcium to a nadir of 6.9 mg/dl. She subsequently required one dose of intravenous calcium gluconate and then oral calcium carbonate for 5 days post-surgery. Pathology confirmed the diagnosis of small cell carcinoma of ovary. Patient 2 was a 16-year-old girl who presented with a serum calcium of 15.9 mg/dL. She began hyperhydration with isotonic normal saline and 3 doses of calcitonin over a span of 2 days. Despite this serum calcium remained between 11-12 mg/dL and she received one dose of pamidronate 0.37 mg/kg. Serum calcium decreased to 9.1 mg/dl in 41 hours, and she underwent surgical debulking surgery the same day. The lowest post operative calcium was 7.5 mg/dl three days post pamidronate and one day post tumor debulking. Pathology confirmed a diagnosis of dysgerminoma. She required no calcium supplementation.
Conclusions
Small cell carcinoma of ovary and dysgerminoma are rare causes of paraneoplastic hypercalcemia in adolescents. These cases highlight the importance of understanding the mechanism of action, safety, and efficacy of hypercalcemia therapies. It is important to recognize calcitonin has a short duration of therapy of only 24 to 48 hours due to tachyphylaxis. Monitoring for hypocalcemia even after a single dose of bisphosphonate is critical. Close monitoring is needed if patients plan to undergo tumor resection within the next week as bisphosphonate therapies are known to have a long half-life.
Included in
Higher Education and Teaching Commons, Medical Education Commons, Pediatrics Commons, Science and Mathematics Education Commons
Bisphosphonate Treatment in Pediatric Patients with Rare Ovarian Malignancy and Hypercalcemia: A Case Series
Objectives
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. 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 levels, symptoms and medication side effects were monitored before and after bisphosphonate therapy.
Results
Both girls presented with severe hypercalcemia. Patient 1 was an 11-year old girl who presented with serum calcium of 15.0 mg/dL. She began hyperhydration with isotonic normal saline and calcitonin. Serum calcium transiently decreased to 11.7 mg/dL after the first dose of calcitonin and 24 hours after hyperhydration. However, it increased to its highest peak of 14.1 mg/dL despite hyperhydration and 4 doses of calcitonin over a span of 4 days. Therefore, she received one dose of zoledronic acid 0.1 Unit/kg. Calcium decreased to 10.4 mg/dl in 56 hours after zoledronic acid administration. She underwent tumor resection 3 days after medication administration which further decreased serum calcium to a nadir of 6.9 mg/dl. She subsequently required one dose of intravenous calcium gluconate and then oral calcium carbonate for 5 days post-surgery. Pathology confirmed the diagnosis of small cell carcinoma of ovary. Patient 2 was a 16-year-old girl who presented with a serum calcium of 15.9 mg/dL. She began hyperhydration with isotonic normal saline and 3 doses of calcitonin over a span of 2 days. Despite this serum calcium remained between 11-12 mg/dL and she received one dose of pamidronate 0.37 mg/kg. Serum calcium decreased to 9.1 mg/dl in 41 hours, and she underwent surgical debulking surgery the same day. The lowest post operative calcium was 7.5 mg/dl three days post pamidronate and one day post tumor debulking. Pathology confirmed a diagnosis of dysgerminoma. She required no calcium supplementation.
Conclusions
Small cell carcinoma of ovary and dysgerminoma are rare causes of paraneoplastic hypercalcemia in adolescents. These cases highlight the importance of understanding the mechanism of action, safety, and efficacy of hypercalcemia therapies. It is important to recognize calcitonin has a short duration of therapy of only 24 to 48 hours due to tachyphylaxis. Monitoring for hypocalcemia even after a single dose of bisphosphonate is critical. Close monitoring is needed if patients plan to undergo tumor resection within the next week as bisphosphonate therapies are known to have a long half-life.
