Hypercalcaemia: prednisolone decreased hypercalcaemia.

Clinical bottom line (level 1b)

  1. Women with severe malignant hypercalcaemia in breast cancer who were given prednisolone, were more likely to achieve normocalcaemia than those given rehydration and furosemide without prednisolone (NNT = 2 at 8 days) .
Kristensen et al: Journal of Internal Medicine 1992; 232: 237-245
Expires January 2003

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: general hospital, Denmark

30 patients (aged range 42 to 73 years; mean 57, 100% female) serum ionised calcium >1.60 mmol/L and had histologically confirmed adenocarcinoma of the breast

Excluded if
  • other known disorders of calcium homeostasis
  • contraindications to glucocorticoids
  • use of glucocorticoid and change of systemic antineoplastic treatment less than four weeks previously
  • anti hypercalcaemic treatment less than two weeks previously
  • suspected metastases in the adrenal glands
  • other malignant disease
  • previous inclusion in the study


    • Control Group: (n = 15, 15 analysed): rehydration consisting of 4 L of isotonic saline supplemented with iv furosemide, 80 mg, three times daily on days one and two, subsequently reduced to 3 L saline and 80 mg furosemide twice daily from day 3 to 8.
    Experimental Group: (n = 15, 15 analysed): rehydration and furosemide as controls, plus prednisolone 25 mg orally three times daily for eight days

    100% followed for ? weeks

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    normocalcaemia 8 days 0
    (0.00%)    		 7
    (46.67%)    		 47%
    (14% to 67%)    		 46.67%
    (21.42% to 71.91%)    		 2
    (1 to 5)

    Citation

    1. Kristensen B, Ejlertsen B, Holmegaard SN, et al: Prednisolone in the treatment of severe malignant hypercalcaemia in metastatic breast cancer: a randomized study. Journal of Internal Medicine 1992; 232: 237-245
    Contributor: Clare Wotton and Musab Hayatli, January 2000
    Reviewer:

    Clinical Question.
    Patient severe malignant hypercalcaemia
    Intervention or Exposure prednisolone with rehydration and furosemide
    Comparison rehydration and furosemide alone
    Outcome serum calcium