Calcium and Phosphate Metabolism in Patients with Disseminated Breast Cancer: Effect of Androgens and of Prednisone

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Abstract
The authors measured blood and urine levels of total calcium, protein-free calcium, phosphate and creatinine in 75 women with disseminated breast cancer. In 50 patients, before endocrine treatment, serum calcium and phosphate levels were significantly elevated without change in renal clearance of tubular reabsorption of calcium or of phosphate. Preterminally, glomerular filtration fell significantly. Androgen treatment in 34 women lowered serum calcium and phosphate levels, but did not change clearance or tubular reabsorption of calcium or of phosphate. Prednisone, 30 mg, plus triiodothyronine, 50 μg daily, given to 24 patients farther along in the course of their disease, when the glomerular filtration rate was lower, increased clearances of calcium and phosphate by lowering tubular reabsorption. The serum phosphate level fell but the serum calcium level was maintained. The authors interpret these findings to mean that breast cancer produces osteolysis with or without osseous metastases and preterminally damages renal function. Androgens decrease osteolysis. Prednisone causes renal wasting of calcium and phosphate, thus lowering the serum phosphate level, but the serum calcium level is maintained, probably by an unidentified osteolytic mechanism.

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