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The purpose of this case report is to highlight potentially life-threatening severe hypocalcaemia as a side effect of denosumab complicated by refractory shock that failed to respond to medical management including intravenous calcium, vasopressors and inotropes in an elderly man with a history of prostatic cancer.<\/jats:p>","DOI":"10.12890\/2022_003706","type":"journal-article","created":{"date-parts":[[2022,12,23]],"date-time":"2022-12-23T04:18:50Z","timestamp":1671769130000},"source":"Crossref","is-referenced-by-count":2,"title":["Refractory Shock Secondary to Denosumab-induced Severe Hypocalcaemia"],"prefix":"10.12890","volume":"9","author":[{"given":"Nouran","family":"Eshak","sequence":"first","affiliation":[{"name":"Geriatric Division, Family Medicine Department, Texas Tech University Health Sciences Center, Lubbock, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahmoud","family":"Abdelnabi","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Texas Tech University Health Sciences Center, Lubbock, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juthipong","family":"Benjanuwattra","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Texas Tech University Health Sciences Center, Lubbock, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amr","family":"Ismail","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Texas Tech University Health Sciences Center, Lubbock, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natnicha","family":"Leelaviwat","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Texas Tech University Health Sciences Center, Lubbock, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeyad","family":"Elharabi","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Texas Tech University Health Sciences Center, Lubbock, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Culberson","sequence":"first","affiliation":[{"name":"Geriatric Division, Family Medicine Department, Texas Tech University Health Sciences Center, Lubbock, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10397","published-online":{"date-parts":[[2022,12,23]]},"reference":[{"key":"10.12890\/2022_003706_ref1","doi-asserted-by":"crossref","unstructured":"<li>Hanley D, Adachi J, Bell A, Brown V. Denosumab: mechanism of action and clinical outcomes. <em>Int J Clin Pract<\/em> 2012;<strong>66<\/strong>:1139\u20131146.<\/li>","DOI":"10.1111\/ijcp.12022"},{"key":"10.12890\/2022_003706_ref2","doi-asserted-by":"crossref","unstructured":"<li>Kim D. Hypocalcemia after the administration of denosumab in a patient with osteoporotic fracture and vitamin D deficiency.<em> J Endocrinol Metabol<\/em> 2022;<strong>12<\/strong>:111\u2013115.<\/li>","DOI":"10.14740\/jem810"},{"key":"10.12890\/2022_003706_ref3","doi-asserted-by":"crossref","unstructured":"<li>Laskowski LK, Goldfarb DS, Howland MA, Kavcsak K, Lugassy DM, Smith SW. A RANKL wrinkle: denosumab-induced hypocalcemia. <em>J Med Toxicol<\/em> 2016;<strong>12<\/strong>:305\u2013308.<\/li>","DOI":"10.1007\/s13181-016-0543-y"},{"key":"10.12890\/2022_003706_ref4","doi-asserted-by":"crossref","unstructured":"Tohme JF, Bilezikian JP. Hypocalcemic emergencies. <em>Endocrinol Metab Clin North Am <\/em>1993;<strong>22<\/strong>:363\u2013375.<\/li>","DOI":"10.1016\/S0889-8529(18)30171-3"},{"key":"10.12890\/2022_003706_ref5","doi-asserted-by":"crossref","unstructured":"<li>Olson SW, Deal LE, Piesman M. Epinephrine-secreting pheochromocytoma presenting with cardiogenic shock and profound hypocalcemia. <em>Ann Intern Med<\/em> 2004;<strong>140<\/strong>:849\u2013851.<\/li>","DOI":"10.7326\/0003-4819-140-10-200405180-00033"},{"key":"10.12890\/2022_003706_ref6","doi-asserted-by":"crossref","unstructured":"<li>Patell K, Ajay K, Al Armashi AR, Bawwab A, Ravakhah K. Life-threatening sustained hypocalcemia following denosumab use in metastatic prostate cancer. <em>J Oncol Pharm Pract<\/em> 2022;<strong>28<\/strong>:698\u2013702.<\/li>","DOI":"10.1177\/10781552211055407"}],"container-title":["European Journal of Case Reports in Internal Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/3706\/3320","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/3706\/3321","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/3706\/3321","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T13:37:45Z","timestamp":1755783465000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/view\/3706"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,23]]},"references-count":6,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.12890\/2022_003706","relation":{"has-manifestation":[{"id-type":"other","id":"1-93-3706-g3320","asserted-by":"subject"},{"id-type":"other","id":"1-93-3706-g3321","asserted-by":"subject"}],"is-part-of":[{"id-type":"other","id":"1-93","asserted-by":"subject"}]},"ISSN":["2284-2594"],"issn-type":[{"type":"electronic","value":"2284-2594"}],"subject":[],"published":{"date-parts":[[2022,12,23]]}}}