Refractory Shock Secondary to Denosumab-induced Severe Hypocalcaemia

Nouran Eshak; Mahmoud Abdelnabi; Juthipong Benjanuwattra; Amr Ismail; Natnicha Leelaviwat; Zeyad Elharabi; John Culberson

doi:10.12890/2022_003706

Refractory Shock Secondary to Denosumab-induced Severe Hypocalcaemia

Eur J Case Rep Intern Med. 2022 Dec 23;9(12):003706. doi: 10.12890/2022_003706. eCollection 2022.

Authors

Nouran Eshak¹, Mahmoud Abdelnabi², Juthipong Benjanuwattra², Amr Ismail², Natnicha Leelaviwat², Zeyad Elharabi², John Culberson¹

Affiliations

¹ Geriatric Division, Family Medicine Department, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.
² Internal Medicine Department, Texas Tech University Health Sciences Center, Lubbock, Texas.

Abstract

Denosumab is one of the most commonly used antiresorptive drugs for osteoporosis treatment and the prevention of skeletal-related events in cancer patients. 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.

Learning points: Denosumab is a commonly used antiresorptive drugs for the treatment of osteoporosis and to prevent skeletal-related events in patients with cancer.A common side effect of denosumab is hypocalcaemia; conditions associated with a higher risk of hypocalcaemia include chronic kidney disease, pre-existing hypocalcaemia, and metastatic cancer.Severe hypocalcaemia may induce cardiovascular manifestations such as hypotension, bradycardia, impaired cardiac contractility, impaired vascular tone, and arrhythmias.Shock results from diminished vascular smooth muscle tone and tends to occur with rapid severe hypocalcaemia; it is usually refractory to fluid and pressor therapy until hypocalcaemia is corrected.

Keywords: Refractory shock; cardiogenic shock; denosumab; severe hypocalcaemia.