Octreotide for the Treatment of Hypercalcemia Related to B Cell Lymphoma

Dear Sir, Severe hypercalcemia represents a lifethreatening emergency and its management is still difficult. Patients with malignancies who develop hypercalcemia generally have a poor outcome [1]. The administration of fluids, diuretics, steroids, diphosphonates, calcitonin and hemodialysis are the most common therapeutic options [2], We report the case of a patient with hypercalcemia related to B cell lymphoma in whom all the above-mentioned therapeutic measures failed to decrease serum calcium level. It was then normalized by the use of the long-acting somatostatin analogue octreotide. A 76-year-old woman with peripheral large-cell type B lymphoma [3] was admitted to our emergency department with coma and jaundice. Blood examinations revealed severe hypercalcemia (serum calcium 4.3 mmol/l; normal values 2.1-2.8), hypophosphatemia and hemolytic anemia. Plasma PTH was undetectable ( < 10 pg/ml, normal range 10-70 pg/ml). The administration of large amounts of fluids (6,000 ml/day), furo-semide, steroids and diphosphonates at the optimal doses currently suggested was started intravenously; anemia was corrected with blood transfusions. In the following 24 h, no significant changes in consciousness and serum calcium levels (4.1 mmol/l) were observed. Calcitonin (Calcitonina, Sandoz Prodotti Farmaceutici, Milan, Italy) at the dose of 24 IU/kg/24 h was added intravenously (fig. 1) and on the 4th day following admission, for persistent hypercalcemia