Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-20T05:24:01.206Z Has data issue: false hasContentIssue false
  • English
  • Français

Hypercalcemia due to methadone-induced adrenal insufficiency in a case of oral cancer

Published online by Cambridge University Press:  29 October 2020

Ankit Sharma ,
Mahajan Jitendra Subhash ,
Anuja Pandit Open the ORCID record for Anuja Pandit [Opens in a new window] ,
Swati Bhan  and
Sushma Bhatnagar
Ankit Sharma
Affiliation:
Department of Onco-Anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
Mahajan Jitendra Subhash
Affiliation:
Department of Onco-Anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
Anuja Pandit*
Affiliation:
Department of Onco-Anesthesia and Palliative Medicine, National Cancer Institute (AIIMS), Jhajjar, Haryana, India
Swati Bhan
Affiliation:
Department of Onco-Anesthesia and Palliative Medicine, National Cancer Institute (AIIMS), Jhajjar, Haryana, India
Sushma Bhatnagar
Affiliation:
Department of Onco-Anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
*
Author for correspondence: Anuja Pandit, Assistant Professor, Department of Onco-Anesthesia and Palliative Medicine, National Cancer Institute (AIIMS), Academic Block, NCI-AIIMS, Badsa, Jhajjar, Haryana 124105, India. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

A 31-year-old patient of post-surgical recurrent buccal carcinoma (post-chemo and radiotherapy) on multimodal analgesia with methadone, paracetamol and gabapentin presented to pain clinic with occasional bleeding from tumor area and incidental hypercalcemia. The hypercalcemia was attributed to adrenal insufficiency due to methadone, with no other obvious reasons identified for hypercalcemia or adrenal insufficiency. The patient was managed with the change of opioid, regular aseptic wound dressings and management of hypercalcemia with hydration, calcitonin and steroid therapy. Hypercalcemia in a cancer patient can have multiple other causes like hypercalcemia of malignancy and primary or secondary parathyroid carcinoma. A strong clinical suspicion and appropriate battery of tests may be required to arrive at the diagnosis. Prompt management, including identification and management of the primary pathology along with aggressive hydration with hormonal therapy, may prove to be life-saving.

Keywords

Adrenal insufficiencyAnalgesicsHypercalcemiaMethadoneOpioid
Type
Case Report
Information
Palliative & Supportive Care , Volume 18 , Issue 6 , December 2020 , pp. 751 - 753
Check for updates
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Alinejad, S, Kazemi, T, Zamani, N, et al. (2015) A systematic review of the cardiotoxicity of methadone. EXCLI Journal 14, 577.Google ScholarPubMed
Bajorunas, DR (1990) Clinical manifestations of cancer-related hypercalcemia. Seminars in Oncology 17(2 Suppl 5), 16–25.Google ScholarPubMed
Caraceni, A, Hanks, G, Kaasa, S, et al. (2012) Use of opioid analgesics in the treatment of cancer pain: Evidence-based recommendations from the EAPC. The Lancet Oncology 13(2), e58–e68.CrossRefGoogle ScholarPubMed
Donegan, D and Bancos, I (2018) Opioid-induced adrenal insufficiency. Mayo Clinic Proceedings 93(7), 937–944.CrossRefGoogle Scholar
Garcia, JB and Neto, JO (2020) Living without the opioid epidemic: How far have we come? The Lancet Neurology 19(1), 16.CrossRefGoogle ScholarPubMed
Lee, AS and Twigg, SM (2015) Opioid-induced secondary adrenal insufficiency presenting as hypercalcaemia. Endocrinology, Diabetes & Metabolism Case Reports 2015(1).CrossRefGoogle ScholarPubMed
Muls, E, Bouillon, R, Boelaert, J, et al. (1982) Etiology of hypercalcemia in a patient with Addison's disease. Calcified Tissue International 34, 523–526.CrossRefGoogle Scholar
Mundy, GR and Martin, TJ (1982) The hypercalcemia of malignancy: Pathogenesis and management. Metabolism 31(12), 1247–1277.CrossRefGoogle ScholarPubMed
Ralston, SH, Gallacher, SJ, Patel, U, et al. (1990) Cancer-associated hypercalcemia: Morbidity and mortality: Clinical experience in 126 treated patients. Annals of Internal Medicine 112(7), 499–504.CrossRefGoogle ScholarPubMed
Saeed, M, Khan, M, Taweesedt, PT, et al. (2019) Methadone induced adrenal insufficiency. In: American Thoracic Society 2019 International Conference. A46. Critical Care Case Reports: Acid Base, Electrolytes, Endocrine, Metabolic and Renal, May 17-22, 2019; Dallas, Texas, USA, pp. A1721–A1721.Google Scholar
Willems, D, Gillet, C, Cogan, E, et al. (1991) Biological parameters of bone remodelling in chronic adrenal insufficiency. Hormone and Metabolic Research 23, 511–512.CrossRefGoogle ScholarPubMed