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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: anujapandit@yahoo.co.in
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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
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

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