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Hypercalcaemia approach

Peter J Simm, Andrew Biggin, Margaret R Zacharin, Christine P Rodda, Elaine Tham, Aris Siafarikas, Craig Jefferies, Paul L Hofman, Diane E Jensen, Helen Woodhead, Justin Brown, Benjamin J Wheeler, Denise Brookes, Antony Lafferty, Craig F Munns
Bisphosphonate therapy is the mainstay of pharmacological intervention in young people with skeletal fragility. The evidence of its use in a variety of conditions remains limited despite over three decades of clinical experience. On behalf of the Australasian Paediatric Endocrine Group, this evidence-based consensus guideline presents recommendations and discusses the graded evidence (using the GRADE system) for these recommendations. Primary bone fragility disorders such as osteogenesis imperfecta are considered separately from osteoporosis secondary to other clinical conditions (such as cerebral palsy, Duchenne muscular dystrophy)...
March 2018: Journal of Paediatrics and Child Health
Feaz Babwah, Harit N Buch
It is well recognised that over the past three to four decades the incidence of asymptomatic primary hyperparathyroidism has increased significantly. However, more recently this pattern has further evolved into a presentation with normocalcaemia and raised parathyroid hormone (PTH) level without the presence of a recognised stimulus for its rise, in the form of vitamin D deficiency or renal impairment. A diagnostic label of normocalcaemic hyperparathyroidism (NPHPT) has been given to this phenotype and in most such individuals, the initial PTH measurement is driven by the presence of metabolic bone disease...
April 2018: Journal of Clinical Pathology
Jonathan Ling, Tara Anderson, Sanchia Warren, Geoffrey Kirkland, Matthew Jose, Richard Yu, Steven Yew, Samantha Mcfadyen, Alison Graver, William Johnson, Lisa Jeffs
Background: The overall incidence of Pneumocystis jirovecii pneumonia (PJP) in solid organ transplant recipients is 5-15%. A timely diagnosis of PJP is difficult and relies on imaging and detection of the organism. Methods: We present a case series of four patients displaying hypercalcaemia with an eventual diagnosis of PJP and document the management of the outbreak with a multidisciplinary team approach. We discuss the underlying pathophysiology and previous reports of hypercalcaemia preceding a diagnosis of PJP...
December 2017: Clinical Kidney Journal
Juan C Osorio, Masha G Jones, Nina Schatz-Siemers, Stephanie J Tang
Malignancy is the most common cause of hypercalcaemia in the inpatient setting. Most cases are caused by tumour production of parathyroid hormone-related protein and osseous metastases. In less than 1% of cases, hypercalcaemia is driven by increased production of 1,25-dihydroxyvitamin D (1,25(OH)2 D), a mechanism most commonly seen in haematological malignancies. Here, we describe a woman with metastatic small cell cervical carcinoma who developed hypercalcaemia secondary to paraneoplastic overproduction of 1,25(OH)2 D, a finding that, to our knowledge, has not been previously associated with this cancer...
November 23, 2017: BMJ Case Reports
Giuseppe Maltese, Louise Izatt, Barbara M McGowan, Kashif Hafeez, Johnathan G Hubbard, Paul V Carroll
We describe a rare case of homozygous inactivating calcium-sensing receptor mutation detected during pregnancy and mimicking primary hyperparathyroidism. In pregnancy, the differential diagnosis of hypercalcaemia requires a cautious approach as physiological changes in calcium homeostasis may mask rare genetic conditions.
October 2017: Clinical Case Reports
Oi Lin Lee, Noemi Horvath, Cindy Lee, Doug Joshua, Joy Ho, Jeff Szer, Hang Quach, Andrew Spencer, Simon Harrison, Peter Mollee, Andrew W Roberts, Dipti Talaulikar, Ross Brown, Bradley Augustson, Silvia Ling, Wilfrid Jaksic, John Gibson, Anna Kalff, Anna Johnston, Akash Kalro, Chris Ward, H Miles Prince, Andrew Zannettino
Multiple myeloma (MM) is a haematological malignancy characterised by the clonal proliferation of plasma cells in the bone marrow. More than 80% of patients with MM display evidence of myeloma bone disease (MBD), characterised by the formation of osteolytic lesions throughout the axial and appendicular skeleton. MBD significantly increases the risk of skeletal-related events such as pathologic fracture, spinal cord compression and hypercalcaemia. MBD is the result of MM plasma cells-mediated activation of osteoclast activity and suppression of osteoblast activity...
August 2017: Internal Medicine Journal
B Désirée Ballhausen, Astrid Wehner, Martin Zöllner, Katrin Hartmann, Stefan Unterer
Hypercalcaemia can be caused by many different diseases. This article summarizes the causes, pathophysiologic mechanisms and diagnostic procedures as well as treatment recommendations. The main focus is on hypercalcaemia in primary hyperparathyroidism (PH), complemented by a case report. An elevated total calcium level should generally be investigated and verified by measurement of ionized calcium concentration. The further diagnostic approach depends on the phosphate level. Tumour screening, measurement of parathormone and parathromone-related protein and sonography of parathyroid glands may be necessary...
April 19, 2017: Tierärztliche Praxis. Ausgabe K, Kleintiere/Heimtiere
Nicholas Bingham, Antonia Reale, Andrew Spencer
Multiple myeloma is an incurable clonal plasma cell malignancy characterised by osteolytic bone lesions and the presence of a monoclonal immunoglobulin. The bone disease caused by myeloma is a major cause of morbidity with the related complications of pathological fractures, hypercalcaemia and bone pain affecting both quality of life and patient survival. The osteolytic lesions arise due to an imbalance of osteoclast and osteoblast function, arising from complex interactions between myeloma cells, bone marrow stromal cells and the bone marrow microenvironment...
April 2017: Current Hematologic Malignancy Reports
C Grávalos, C Rodríguez, A Sabino, M Á Seguí, J A Virizuela, A Carmona, J Cassinello, D Isla, C Jara, M Martín
Bone metastases are common in many advanced solid tumours, being breast, prostate, thyroid, lung, and renal cancer the most prevalent. Bone metastases can produce skeletal-related events (SREs), defined as pathological fracture, spinal cord compression, need of bone irradiation or need of bone surgery, and hypercalcaemia. Patients with bone metastases experience pain, functional impairment and have a negative impact on their quality of life. Several imaging techniques are available for diagnosis of this disease...
December 2016: Clinical & Translational Oncology
Julie Huynh, Thao Lu, Danny Liew, James Cg Doery, Ronald Tudball, Madeleine Jona, Roisin Bhamjee, Christine P Rodda
AIM: There are no published data to demonstrate the efficacy of bolus dose vitamin D in newborn infants. The study sought to evaluate this alternative approach of supplementation. METHODS: This single centre, open randomised controlled trial was conducted from August 2013 to May 2014. It compared the efficacy and safety of daily (400 IU) versus a bolus dose (50 000 IU) of cholecalciferol in newborn infants of vitamin D deficient mothers. The primary outcome measure was the rate of 25 hydroxyvitamin D (25OHD) repletion-defined as 25OHD greater than 50 nmol/L...
February 2017: Journal of Paediatrics and Child Health
V Meier, G Polton, S Cancedda, M Roos, P Laganga, T Emmerson, C Rohrer Bley
Stage 3b anal sac gland carcinoma (ASGC) can be life-threatening. A surgical approach is not always possible or may be declined. Dogs with stage 3b ASGC treated with surgery or conformal radiation therapy (RT) with 8 × 3.8 Gy (total dose 30.4 Gy, over 2.5 weeks) were retrospectively evaluated. Patient characteristics, median progression-free interval (PFI) and median survival time (MST) were compared. Twenty-eight dogs were included; 15 underwent surgery, 13 underwent RT. At the time of presentation, 21% showed life-threatening obstipation and 25% showed hypercalcaemia...
September 2017: Veterinary and Comparative Oncology
Natalie C Finch
PRACTICAL RELEVANCE: Calcium is essential for many normal physiological processes within the body. Aberrations in calcium homeostasis leading to hypercalcaemia can result in clinical signs such as polyuriav and polydipsia, lethargy and weakness due to depressed excitability of muscle and nervous tissue, and gastrointestinal (GI) signs due to effects on GI smooth muscle. Hypercalcaemia in cats is mostly idiopathic, with chronic kidney disease and neoplasia also being common causes. CLINICAL CHALLENGES: Hypercalcaemia can be a diagnostic challenge and a good understanding of the regulation of calcium homeostasis can aid in interpreting results of diagnostic tests...
May 2016: Journal of Feline Medicine and Surgery
Rachel K Crowley, Neil J Gittoes
Normocalcaemic hyperparathyroidism is a common biochemical finding, usually identified during an assessment of bone or renal health. Hypercalcaemia must be considered by calculation of adjusted calcium, and a careful history taken to assess dietary calcium intake and for the possibility of a malabsorption syndrome. 25-hydroxyvitamin D (25OHD) should be measured and replaced if indicated. The management plan for the patient is influenced by the context in which calcium and PTH were measured. In this brief review we describe the assessment of a patient with normocalcaemic hyperparathyroidism...
June 2016: Clinical Endocrinology
Uday Yanamandra, Alka Khadwal, Uma Nahar Saikia, Pankaj Malhotra
Acute promyelocytic leukaemia is among the most curable haematological malignancies after the introduction of differentiating agents (arsenic trioxide (ATO) and all-trans-retinoic-acid (ATRA)). Despite excellent cure rates, approaching 85-95% in various series, APL is associated with significant early mortality and morbidity. ATRA-related side effects partly contribute to this morbidity, which commonly presents as differentiation syndrome, pseudo tumour cerebri, dermatitis, gastrointestinal disorders, liver dysfunction (raised transaminases) and dryness of skin/eyes...
January 20, 2016: BMJ Case Reports
Fabio Medas, Enrico Erdas, Alessandro Longheu, Luca Gordini, Giuseppe Pisano, Angelo Nicolosi, Pietro Giorgio Calò
INTRODUCTION: Over the last decades, mini-invasive surgery has become increasingly common for treatment of primary hyperparathyroidism; such approach requires preoperative localization of a suspected parathyroid adenoma. Neck ultrasound (US) and technetium-99 m sestamibi (MIBI) scan are the main imaging studies used for this purpose. The aim of the present study is to evaluate what pre- and post-operative factors may alter the reliability of localization studies. METHODS: A retrospective analysis on 212 patients with preoperative diagnosis of primary hyperparathyroidism was conducted...
January 2016: International Journal of Surgery
Maurizio Iacobone, Bruno Carnaille, F Fausto Palazzo, Menno Vriens
BACKGROUND: Hereditary hyperparathyroidism has been reported to occur in 5-10 % of cases of primary hyperparathyroidism in the context of multiple endocrine neoplasia (MEN) types 1, 2A and 4; hyperparathyroidism-jaw tumour (HPT-JT); familial isolated hyperparathyroidism (FIHPT); familial hypocalciuric hypercalcaemia (FHH); neonatal severe hyperparathyroidism (NSHPT) and autosomal dominant moderate hyperparathyroidism (ADMH). This paper aims to review the controversies in the main genetic, clinical and pathological features and surgical management of hereditary hyperparathyroidism...
December 2015: Langenbeck's Archives of Surgery
A Carter, A G Ortega-Loayza, J Barrett, J Nunley
Calciphylaxis is characterized by abnormal calcification of vessels and skin; however, its aetiology and pathogenesis remain unclear. Entities frequently associated with calciphylaxis are end-stage renal disease, diabetes mellitus, hypercalcaemia, hyperphosphataemia, elevated calcium-phosphate product, hyperparathyroidism and possible hypercoagulable states. Skin lesions may remain quiescent or may develop suddenly and progress rapidly. They are more common on the legs. Treatment of calciphylaxis is very challenging and requires interdisciplinary management...
April 2016: Clinical and Experimental Dermatology
G Garas, M Poulasouchidou, A Dimoulas, P Hytiroglou, M Kita, E Zacharakis
Giant parathyroid adenomas constitute a rare clinical entity, particularly in the developed world. We report the case of a 53-year-old woman where the initial ultrasonography significantly underestimated the size of the lesion. The subsequent size and weight of the adenoma (7 cm diameter, 27 g) combined with the severity of the hypercalcaemia raised the suspicion for the presence of a parathyroid carcinoma. This was later disproven by the surgical and histological findings. Giant parathyroid adenomas are encountered infrequently among patients with primary hyperparathyroidism, and appear to have distinct clinical and biochemical features related to specific genomic alterations...
May 2015: Annals of the Royal College of Surgeons of England
Pierre-Marie Lavrut, François Le Loarer, Charline Normand, Céline Grosos, Rémi Dubois, Annie Buenerd, Cécile Conter, Frédérique Dijoud, Jean-Yves Blay, Sophie Collardeau-Frachon
Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT), is a highly aggressive neoplasm that typically occurs in young females. Paraneoplastic hypercalcemia is associated in two thirds of the cases. Recent studies demonstrated that this rare tumor harbors the same molecular features of malignant rhabdoid tumor secondary to SMARCA4/BRG1 mutations. We illustrate herein a typical bilateral case of SCCOHT with comprehensive molecular characterization in a 14-year-old girl. We also discuss the value of SMARCA4 immunostaining in the diagnostic approach of undifferentiated ovarian and pelvic malignancies...
January 2016: Pediatric and Developmental Pathology
Justin H Davies
Hypercalcaemia is rare in children. In adulthood, the causes are most frequently malignancy and primary hyperparathyroidism. In children, however, the aetiologies are diverse and age specific, and many have an underlying genetic basis. Hypercalcaemia is a serious condition that frequently leads to end-organ damage. In order to provide the most appropriate treatment, a key part of the management pathway is to establish the correct diagnosis promptly. When considering a practical approach to hypercalcaemia in children, it is helpful to consider the causes of hypercalcaemia according to the accompanying levels of parathyroid hormone (PTH), indicating whether the causes are PTH dependent or PTH independent...
2015: Endocrine Development
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