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Course of serum calcium levels in a patient with metastatic renal cell carcinoma and simultaneous elevation in serum parathyroid hormone–related peptide and 1,25-dihydroxyvitamin D before and during bisphosphonate and glucocorticoid therapy. Shaded area represents reference range for serum calcium. Arrows represent timing of 90-mg pamidronate intravenous infusions. Bisphosphonate therapy was ineffective in treating the hypercalcemia, but resolution occurred with glucocorticoids.
