Rebound Hypercalcemia in a 14-Year-Old After Denosumab Therapy for Giant Cell Granuloma of the Mandible.

BACKGROUND/

OBJECTIVE

Giant cell granuloma of the bones is often treated with Denosumab. One side effect of this treatment is rebound hypercalcemia after discontinuation of denosumab. Currently, there are no particular guidelines for treating this rebound hypercalcemia.

METHODS

We describe a case of a 14-year-old male who presented with symptomatic hypercalcemia following the discontinuation of denosumab. He presented to the emergency department with abdominal pain, nausea, and vomiting and was found to have elevated serum calcium at 16.1 mg/dL (2.95 mmol/L).

RESULT: He was treated with zoledronic acid and calcitonin. Three doses of zoledronic acid were required before his calcium levels normalized.

CONCLUSION

There are currently no guidelines regarding the monitoring and treating hypercalcemia following Denosumab therapy, but IV hydration and zoledronic acid have shown promising results. This case report adds to the limited data that zoledronic acid can be used as a first-line therapy for rebound hypercalcemia following Denosumab use.