Hypercalcemia is the most common paraneoplastic syndrome of malignancy (Fojo 2005). Among genitourinary malignancies, it is most frequently identified in association with RCC (3%-25%) (Zekri et al. 2001; Walther et al. 1997; Papac and Poo-Hwu 1999; Skinner et al. 1971). In comparison, hypercalcemia is an uncommon manifestation of prostate cancer and transitional cell carcinoma (Coleman 1997). The incidence of hypercalcemia in RCC correlates with the stage of the primary tumor as well as with the presence or absence of bone metastases (Fahn et al. 1991). Hypercalcemia typically occurs late in the course of disease and has demonstrated independent significance as a poor prognostic factor in patients with advanced RCC (Motzer et al. 1999).
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