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A single dose (120 mg) of denosumab was given and his calcium level plummeted from 14.8 mg\/dL to 5.5 mg\/dL. After second lung metastasectomy, he developed prolonged hypocalcaemia that required calcium and vitamin D supplements for more than 3 years. In patients with severe hypercalcaemia refractory to conventional therapies, denosumab has been used off-label with some success. A known side effect of denosumab is hypocalcaemia, which is often short-lived. The risk of prolonged hypocalcaemia should be fully evaluated before using denosumab preoperatively, especially in patients with renal insufficiency, prolonged hyperparathyroidism or anticipated tumour debulking surgery.<\/jats:p>","DOI":"10.1136\/bcr-2019-233665","type":"journal-article","created":{"date-parts":[[2020,4,29]],"date-time":"2020-04-29T03:55:31Z","timestamp":1588132531000},"page":"e233665","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Pitfalls of using denosumab preoperatively to treat refractory severe hypercalcaemia"],"prefix":"10.1136","volume":"13","author":[{"given":"Yulong","family":"Li","sequence":"first","affiliation":[{"name":"Department of Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris Y","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Manni","sequence":"additional","affiliation":[{"name":"Department of Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William F","family":"Simonds","sequence":"additional","affiliation":[{"name":"Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,4,28]]},"reference":[{"key":"2025082710142043000_13.4.e233665.1","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/j.beem.2018.09.006","article-title":"Non-Surgical management of primary hyperparathyroidism","volume":"32","author":"Cetani","year":"2018","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"2025082710142043000_13.4.e233665.2","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1055\/a-1049-0647","article-title":"Diagnosis, pathophysiology and management of hypercalcemia in malignancy: a review of the literature","volume":"51","author":"Asonitis","year":"2019","journal-title":"Horm Metab Res"},{"key":"2025082710142043000_13.4.e233665.3","doi-asserted-by":"publisher","DOI":"10.1111\/ijcp.12022"},{"key":"2025082710142043000_13.4.e233665.4","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcu166"},{"key":"2025082710142043000_13.4.e233665.5","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcw019"},{"key":"2025082710142043000_13.4.e233665.6","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-14-0482"},{"key":"2025082710142043000_13.4.e233665.7","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcw013"},{"key":"2025082710142043000_13.4.e233665.8","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-3031"},{"key":"2025082710142043000_13.4.e233665.9","doi-asserted-by":"publisher","DOI":"10.5694\/mja12.11243"},{"key":"2025082710142043000_13.4.e233665.10","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-14-0166"},{"key":"2025082710142043000_13.4.e233665.11","doi-asserted-by":"publisher","DOI":"10.4158\/EP14410.OR"},{"key":"2025082710142043000_13.4.e233665.12","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcw206"},{"key":"2025082710142043000_13.4.e233665.13","first-page":"e141","article-title":"Denosumab for the treatment of refractory hypercalcemia in metastatic parathyroid carcinoma","volume":"1","author":"Itoshima","year":"2015","journal-title":"AACE Clin Case Rep"},{"key":"2025082710142043000_13.4.e233665.14","first-page":"150082","article-title":"Palliative treatment of uncontrollable hypercalcemia due to parathyrotoxicosis: denosumab as rescue therapy","volume":"2015","author":"Jumpertz von Schwartzenberg","year":"2015","journal-title":"Endocrinol Diabetes Metab Case Rep"},{"key":"2025082710142043000_13.4.e233665.15","unstructured":"Shane E , Berenson JR . Treatment of hypercalcemia. In: Rosen JC, Mulder EJ, editors. UpToDate [Internet]. Waltham (MA): UpToDate Inc, 2019. Available: www-uptodate-com.medjournal.hmc.psu.edu:2200\/contents\/treatment-of-hypercalcemia [Accessed 30 Jul 2019]."},{"key":"2025082710142043000_13.4.e233665.16","unstructured":"Denosumab [package insert] . U.S. food and drug administration, 2018. 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