Pathophysiology

• Extremely rare in children, as associated with adult cancers such as breast, thyroid and prostate.
• May occur in context of extensive metastatic bone disease or hormone-secreting tumours.

Signs and symptoms

• Severe and intolerable symptoms – must be treated urgently.
• Pain (bone and abdominal).
• Nausea and vomiting.
• Confusion.
• Polyuria

Management

• Involve specialist palliative care team early.
• Treat underlying cause if possible (e.g. radiotherapy to multiple lytic lesions caused by leukaemia).
• Parenteral fluids.
• Bisphosphonate therapy (seek guidance from specialist paediatric palliative team).