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de Brito GA, Caires RA, Coelho FO, Campos MFT, da Cunha DF, Costalonga EC, Pereira BJ, Durão MDS, Amorim F, dos Santos AME, Guedes FL, Silva VTCE. Kidney care in patients with cancer: perspectives from the onconephrology committee of the Brazilian Society of Nephrology. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e2024S121. [PMID: 38865541 PMCID: PMC11164260 DOI: 10.1590/1806-9282.2024s121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 06/14/2024]
Affiliation(s)
| | - Renato Antunes Caires
- São Paulo State Cancer, Institute e University of São Paulo School of Medicine – São Paulo (SP), Brazil
| | | | | | | | - Elerson Carlos Costalonga
- São Paulo State Cancer, Institute e University of São Paulo School of Medicine – São Paulo (SP), Brazil
| | | | - Marcelino de Souza Durão
- Universidade Federal de São Paulo, Paulista School of Medicine, Discipline of Nephrology – São Paulo (SP), Brazil
- Hospital Israelita Albert Einstein, Kidney Transplant Unit – São Paulo (SP), Brazil
| | - Fernanda Amorim
- State Public Servant Hospital, Nephrology Service – São Paulo (SP), Brazil
| | | | - Felipe Leite Guedes
- Universidade Federal do Rio Grande do Norte, Nephrology Service – Natal (RN), Brazil
| | - Verônica Torres Costa e Silva
- São Paulo State Cancer, Institute e University of São Paulo School of Medicine – São Paulo (SP), Brazil
- Universidade de São Paulo, Faculty of Medicine, Medical Research Laboratory (LIM) 16 – São Paulo (SP), Brazil
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2
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Okuyama H, Sato R, Enomoto K, Asakura J, Hatakeyama T. Hypercalcemic Crisis Due to Parathyroid Adenoma Improved by Continuous Hemodialysis with a Common Calcium Concentration Dialysate: Discussion of Therapeutic Management. Intern Med 2024; 63:1139-1147. [PMID: 37690849 PMCID: PMC11081886 DOI: 10.2169/internalmedicine.1764-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/25/2023] [Indexed: 09/12/2023] Open
Abstract
A hypercalcemic crisis due to primary hyperparathyroidism is a life-threatening condition. We herein report a 71-years-old man with hypercalcemic crisis due to primary hyperparathyroidism with parathyroid adenoma. Generally, hemodialysis or continuous hemodiafiltration using calcium-free or low-calcium dialysate is performed early for hypercalcemic crisis. In this case, continuous hemodialysis with a common calcium concentration dialysate improved the hypercalcemic crisis, and parathyroidectomy was performed. The patient recovered sufficiently. Prediction of hypercalcemia crisis, appropriate introduction and methods of blood purification therapy, and timing decisions for parathyroidectomy are required for therapeutic management of hypercalcemic crisis with parathyroid adenoma.
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Affiliation(s)
- Hirohito Okuyama
- Department of Nephrology, Japanese Red Cross Akita Hospital, Japan
| | - Ryuta Sato
- Department of Nephrology, Japanese Red Cross Akita Hospital, Japan
| | | | - Juko Asakura
- Department of Nephrology, Japanese Red Cross Akita Hospital, Japan
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Hattori M, Kikutani K, Ohshimo S, Shime N. Hypercalcemic Crisis Complicated With Acute Respiratory Distress Syndrome Due to Hot Spring Drowning: A Case Report. Cureus 2024; 16:e58431. [PMID: 38765426 PMCID: PMC11099495 DOI: 10.7759/cureus.58431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/22/2024] Open
Abstract
Hypercalcemia is generally treated conservatively, including massive fluid administration. However, in cases of acute respiratory distress syndrome (ARDS) associated with drowning, excessive fluid administration may worsen respiratory status. An 81-year-old female was found drowned in a hot spring at an accommodation facility and urgently transported to our hospital. On arrival, the patient exhibited severe respiratory failure, impaired consciousness, and bilateral lung infiltrates on computed tomography (CT), suggesting ARDS. Blood biochemical tests showed calcium (Ca) of 17.4 mg/dL, with altered consciousness attributed to hypercalcemia. Because of concerns about further deterioration of respiratory status, hemodialysis was performed to avoid massive fluid administration. Post-hemodialysis, blood calcium levels quickly decreased, leading to improved consciousness and respiration; the patient was extubated 48 hours post-admission. Subsequent examinations identified hot spring water aspiration as the cause of hypercalcemia. For hypercalcemia from hot spring drowning with acute respiratory distress syndrome, consider early hemodialysis initiation without excessive fluid administration.
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Affiliation(s)
- Miyuki Hattori
- Department of Emergency and Critical Care Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, JPN
| | - Kazuya Kikutani
- Department of Emergency and Critical Care Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, JPN
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, JPN
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, JPN
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Parodi E, Rossi M, Bottiglieri A, Ladetto M, Merlotti G, Cantaluppi V, Quaglia M. Pharmacotherapy considerations in patients who develop acute kidney injury during anti-cancer therapy. Expert Opin Pharmacother 2024; 25:595-610. [PMID: 38646905 DOI: 10.1080/14656566.2024.2346268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/18/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION Acute kidney injury (AKI) frequently develops in patients receiving cancer therapy and requires a wide differential diagnosis due to possible role of unique cancer and drug-related factors, in addition to common pre- and post-renal causes. Rapid development of new molecular targeted anti-cancer drugs and immunotherapies has opened unprecedented possibilities of treatment at the price of an increased spectrum of renal side effects. AREAS COVERED The present review aims at providing a state-of-the-art picture of AKI in cancer patient (PubMed and Embase libraries were searched from inception to January 2024), with a focus on differential diagnosis and management of diverse clinical settings. Reports of parenchymal AKI due to glomerular, microvascular, tubular and interstitial damage have been constantly increasing. Complex electrolyte and acid-base disorders can coexist. The role of renal biopsy and possible therapeutic approaches are also discussed. EXPERT OPINION Onconephrology has become an important subspecialty of clinical nephrology, requiring constantly updated skills and a high degree of interdisciplinary integration to tackle diagnostic challenges and even therapeutic and ethical dilemmas. Integrated onconephrological guidelines and availability of biomarkers may provide new tools for management of this unique type of patients in the near future.
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Affiliation(s)
- Emanuele Parodi
- Nephrology and Dialysis Unit, "SS Antonio e Biagio e Cesare Arrigo" University Hospital, Alessandria, Italy
| | - Maura Rossi
- Oncology Unit, "SS Antonio e Biagio e Cesare Arrigo" University Hospital, Alessandria, Italy
| | - Achille Bottiglieri
- Oncology Unit, "SS Antonio e Biagio e Cesare Arrigo" University Hospital, Alessandria, Italy
| | - Marco Ladetto
- Hematology Unit, "SS Antonio e Biagio e Cesare Arrigo" University Hospital, Alessandria, Italy
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), Novara, Italy
| | - Guido Merlotti
- Department of Primary Care, "Azienda Socio Sanitaria Territoriale (ASST) of Pavia", Pavia, Italy
| | - Vincenzo Cantaluppi
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), Novara, Italy
- Nephrology and Renal Transplant Unit, "Maggiore della Carita" University Hospital, Novara, Italy
| | - Marco Quaglia
- Nephrology and Dialysis Unit, "SS Antonio e Biagio e Cesare Arrigo" University Hospital, Alessandria, Italy
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), Novara, Italy
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Mehta K, Awan M, Devlin S, Jassal SK. Hypercalcaemia of malignancy: a case of vitamin-D-mediated hypercalcaemia in lymphoma. BMJ Case Rep 2024; 17:e256126. [PMID: 38320825 PMCID: PMC10859978 DOI: 10.1136/bcr-2023-256126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Hypercalcaemia of malignancy (HCM) is a paraneoplastic syndrome that often portends a poor prognosis. We present an extremely rare (<1%) case of HCM due to extrarenal calcitriol (1,25-(OH)2D) production in a patient with splenic marginal zone lymphoma. A man in his 80s presented with a 3-week history of fatigue, unsteadiness and abdominal pain, and new findings of anaemia, kidney injury and hypercalcaemia. Laboratory evaluation, bone marrow biopsy and positron emission tomography/computed tomography (PET/CT) confirmed the diagnosis of splenic marginal zone lymphoma which produced calcitriol (1,25-(OH)2D3), causing the patient's hypercalcaemia.
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Affiliation(s)
- Kanchi Mehta
- Medicine, UC San Diego, La Jolla, California, USA
| | - Maham Awan
- Medicine, UC San Francisco, San Francisco, California, USA
| | - Shannon Devlin
- Washington University in St Louis, St Louis, Missouri, USA
| | - Simerjot Kaur Jassal
- Medicine, UC San Diego, La Jolla, California, USA
- Primary Care, VA San Diego Healthcare System, San Diego, California, USA
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Matsuoka N, Katsuno T, Tagami G, Ishizuka K, Tsuzuki T, Ito Y. Granulocyte-colony stimulating factor producing cervical cancer with elevated levels of parathyroid hormone-related protein: a case report and literature review. CEN Case Rep 2024; 13:45-52. [PMID: 37227595 PMCID: PMC10834895 DOI: 10.1007/s13730-023-00788-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/31/2023] [Indexed: 05/26/2023] Open
Abstract
Systemic effects associated with hormones and cytokines secreted by tumor cells can cause paraneoplastic syndrome. Leukemoid reactions and hypercalcemia are relatively common manifestations of paraneoplastic syndrome. Here, we describe the case of a 90-year-old woman who presented with leukocytosis and hypercalcemia and was diagnosed with granulocyte-colony stimulating factor (G-CSF)-producing cervical cancer with elevated levels of parathyroid hormone-related protein (PTHrP). The patient visited our hospital complaining of general fatigue and anorexia. On admission, she presented with marked leukocytosis, hypercalcemia, and an increase in C-reactive protein level. On the basis of abdominal magnetic resonance imaging and histopathological examination, the patient was diagnosed with cervical cancer. Additional tests confirmed elevated plasma levels of G-CSF, PTHrP, and serum interleukin-6. Immunostaining of pathological specimens of the uterine cervix showed expression of G-CSF in tumor cells. The patient was diagnosed with G-CSF-producing cervical cancer accompanied by elevation of PTHrP levels. As a treatment for hypercalcemia, discontinuation of oral vitamin D derivative and administration of saline and elcatonin were ineffective, and therapeutic intervention with zoledronic acid hydrate was required. Considering the patient's advanced age, surgical resection of cervical cancer was not performed. She died from congestive heart failure approximately 3 months after hospitalization. This case was indicated to be a paraneoplastic syndrome in which G-CSF and PTHrP-induced leukocytosis and hypercalcemia. To the best of our knowledge, there have been no reports of G-CSF-producing cervical cancer with elevated PTHrP levels, and our case is the first report.
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Affiliation(s)
- Naoya Matsuoka
- Department of Nephrology and Rheumatology, Aichi Medical University Medical Center, 17-33 Kawagoshi, Nikki, Okazaki, Aichi, 444-2148, Japan
| | - Takayuki Katsuno
- Department of Nephrology and Rheumatology, Aichi Medical University Medical Center, 17-33 Kawagoshi, Nikki, Okazaki, Aichi, 444-2148, Japan.
| | - Genri Tagami
- Department of Nephrology and Rheumatology, Aichi Medical University Medical Center, 17-33 Kawagoshi, Nikki, Okazaki, Aichi, 444-2148, Japan
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Koki Ishizuka
- Department of Clinical Training Center, Aichi Medical University, Nagakute, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University, Nagakute, Japan
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
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7
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Kim J, Kim N, Jeon Y, Kim TY, Kim TJ, Kwon HS, Park CS, Baek KH. Case 16: A 75-Year-Old Man With Macroglossia and Hypercalcemia. J Korean Med Sci 2023; 38:e374. [PMID: 37967882 PMCID: PMC10643243 DOI: 10.3346/jkms.2023.38.e374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/12/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Jinyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nanyeong Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youngwoo Jeon
- Division of Hematology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tong-Yoon Kim
- Division of Hematology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Jung Kim
- Department of Hospital Pathology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuk-Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Soo Park
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki-Hyun Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Mc Donald D, Drake MT, Crowley RK. Treatment of hypercalcaemia of malignancy in adults. Clin Med (Lond) 2023; 23:503-507. [PMID: 37775175 PMCID: PMC10541286 DOI: 10.7861/clinmed.2023-0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Hypercalcaemia of malignancy (HCM) is a common metabolic complication of advanced malignancies with a prevalence varying from 2-30%, depending on cancer type and disease stage. HCM is associated with impaired quality of life, increased risk of hospitalisation and limited survival. Evidence-based guidelines for management of HCM have been lacking to date, despite its prevalence and detrimental impact. This concise guidance highlights key recommendations from the recent Endocrine Society Clinical Practice Guidelines on Treatment of Hypercalcaemia of Malignancy in Adults, published in December 2022. A systematic review and meta-analysis was commissioned to support the guideline development process. Key suggestions include the use of denosumab in preference to intravenous bisphosphonates as first-line treatment for HCM and the use of denosumab in cases of recurrent or refractory HCM in patients previously treated with intravenous bisphosphonates. The guideline also identifies priority areas for future research.
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Affiliation(s)
| | | | - Rachel K Crowley
- St Vincent's University Hospital, Dublin, and University College Dublin, Ireland
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Yu D, Tang X, Xue H, Ao Y, Xie Y, Li X. Paraneoplastic syndrome in malignant lymphoma: A case report. Heliyon 2023; 9:e18968. [PMID: 37636455 PMCID: PMC10458334 DOI: 10.1016/j.heliyon.2023.e18968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 07/12/2023] [Accepted: 08/03/2023] [Indexed: 08/29/2023] Open
Abstract
Hypercalcaemia associated with malignancy is a complication of advanced tumors. Lactic acidosis is also an extremely rare paraneoplastic syndrome of malignancy, and the presence of both usually indicates an extremely poor prognosis for the tumour. Diffuse large B-cell lymphoma is the most common type of non-Hodgkin's lymphoma and is also a common aggressive lymphoma. It is extremely rare for patients with diffuse large B-cell lymphoma to develop both hypercalcaemia and severe lactic acidosis. In this article, we report a case of CD5 positive diffuse large B-cell lymphoma with hypercalcaemic crisis and persistent lactic acidosis, in which calcium was rapidly reduced to normal after rehydration, diuresis, calcitonin and zoledronate, and continuous renal replacement therapy (CRRT). After correction of acidosis with sodium bicarbonate, diuresis, vitamin B1 and CRRT, the patient's lactate remained at a high level. The aim of this article is to analyse the experience of the combination of hypercalcaemia and intractable lactic acidosis, which should be considered as a serious electrolyte disorder possibly associated with abnormal metabolism of malignant tumors, and to identify and treat the primary lesion as early as possible.
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Affiliation(s)
- Dian Yu
- Lianyungang Clinical College of Nanjing Medical University, China
- Department of Emergency and Critical Care Medicine, The First People's Hospital of Lianyungang, China
- Clinical College of Guizhou Medical University, China
| | - Xinyi Tang
- Lianyungang Clinical College of Nanjing Medical University, China
- Department of Emergency and Critical Care Medicine, The First People's Hospital of Lianyungang, China
| | - Haoyue Xue
- Department of Emergency and Critical Care Medicine, The First People's Hospital of Lianyungang, China
- Lianyungang Clinical College of Xuzhou Medical University, China
| | - Yongfeng Ao
- Clinical College of Guizhou Medical University, China
| | - Yongpeng Xie
- Lianyungang Clinical College of Nanjing Medical University, China
- Department of Emergency and Critical Care Medicine, The First People's Hospital of Lianyungang, China
- Lianyungang Clinical College of Xuzhou Medical University, China
| | - Xiaomin Li
- Lianyungang Clinical College of Nanjing Medical University, China
- Department of Emergency and Critical Care Medicine, The First People's Hospital of Lianyungang, China
- Lianyungang Clinical College of Xuzhou Medical University, China
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Yarandi N, Shirali AC. Onco-Nephrology: Kidney Disease in the Cancer Patient. Med Clin North Am 2023; 107:749-762. [PMID: 37258012 DOI: 10.1016/j.mcna.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Patients with cancer may develop kidney disease with a variety of different clinical manifestations including acute kidney injury, chronic kidney disease, hypertension, proteinuria and electrolyte disturbances. Onco-nephrology is the subspecialty of nephrology that diagnoses and manages kidney disease in patients with cancer. In this article, we review major topics in Onco-Nephrology that may be encountered by the general internist.
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Affiliation(s)
- Niloufarsadat Yarandi
- Section of Nephrology, Yale University School of Medicine, PO Box 208029, New Haven, CT 06520-8029, USA
| | - Anushree C Shirali
- Section of Nephrology, Yale University School of Medicine, PO Box 208029, New Haven, CT 06520-8029, USA.
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Konstantinidou E, Maurer JR, Reyes SL, Baiev I, Stanton JR, Nipp RD, Goyal L. Prevalence and Clinicopathologic Characteristics of Hypercalcemia in Patients With Cholangiocarcinoma. JAMA Oncol 2023; 9:714-717. [PMID: 36951820 PMCID: PMC10037198 DOI: 10.1001/jamaoncol.2023.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/16/2022] [Indexed: 03/24/2023]
Abstract
This cohort study investigates clinicopathologic and prognostic associations of hypercalcemia in patients with intrahepatic or extrahepatic cholangiocarcinoma.
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Affiliation(s)
- Eirini Konstantinidou
- Cancer Center, Beth Israel Deaconess Medical Center, Division of Hematology-Oncology, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jordan R. Maurer
- Mass General Cancer Center, Division of Hematology and Oncology, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Stephanie L. Reyes
- Mass General Cancer Center, Division of Hematology and Oncology, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Islam Baiev
- Mass General Cancer Center, Division of Hematology and Oncology, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jennifer R. Stanton
- Mass General Cancer Center, Division of Hematology and Oncology, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ryan D. Nipp
- Mass General Cancer Center, Division of Hematology and Oncology, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lipika Goyal
- Mass General Cancer Center, Division of Hematology and Oncology, Department of Medicine, Harvard Medical School, Boston, Massachusetts
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Gillion V, Dahan K, Dragean CA, Demoulin N. Nephrolithiasis and Multicystic Kidneys in a Young Patient: A Quiz. Am J Kidney Dis 2023; 81:A9-A11. [PMID: 37087131 DOI: 10.1053/j.ajkd.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/17/2022] [Indexed: 04/24/2023]
Affiliation(s)
- Valentine Gillion
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.
| | - Karin Dahan
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium; Centre de Génétique Humaine, Institut de Pathologie et de Génétique, Gosselies, Belgium
| | - Cristina Anca Dragean
- Department of Medical Imaging, Cliniques universitaires Saint-Luc, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Nathalie Demoulin
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
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Fuleihan GEH, Drake MT. Commentary on the endocrine society clinical practice guideline on the "treatment of hypercalcemia of malignancy in adults". Metabolism 2023; 143:155553. [PMID: 37028591 DOI: 10.1016/j.metabol.2023.155553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 04/09/2023]
Affiliation(s)
- Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, World Health Organization Collaborating Center for Metabolic Bone Disorders, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Matthew T Drake
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN 55902, USA
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Dickens LT, Derman B, Alexander JT. Endocrine Society Hypercalcemia of Malignancy Guidelines. JAMA Oncol 2023; 9:430-431. [PMID: 36637830 DOI: 10.1001/jamaoncol.2022.7941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This guideline synopsis summarizes the Endocrine Society guidelines for hypercalcemia of malignancy in adults.
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Affiliation(s)
- Laura T Dickens
- Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, Illinois
| | - Ben Derman
- Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Jason T Alexander
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois
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Banjongjit A, Kanjanabuch T. Renal sarcoidosis presenting with hypercalcemia, acute kidney injury and proteinuria. Lesson for the clinical nephrologist. J Nephrol 2023; 36:307-310. [PMID: 36350560 DOI: 10.1007/s40620-022-01501-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Athiphat Banjongjit
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Seisa MO, Nayfeh T, Hasan B, Firwana M, Saadi S, Mushannen A, Shah SH, Rajjoub NS, Farah MH, Prokop LJ, Wang Z, Fuleihan GEH, Drake MT, Murad MH. A Systematic Review Supporting the Endocrine Society Clinical Practice Guideline on the Treatment of Hypercalcemia of Malignancy in Adults. J Clin Endocrinol Metab 2023; 108:585-591. [PMID: 36545700 DOI: 10.1210/clinem/dgac631] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Hypercalcemia is a common complication of malignancy that is associated with high morbidity and mortality. OBJECTIVE To support development of the Endocrine Society Clinical Practice Guideline for the treatment of hypercalcemia of malignancy in adults. METHODS We searched multiple databases for studies that addressed 8 clinical questions prioritized by a guideline panel from the Endocrine Society. Quantitative and qualitative synthesis was performed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess certainty of evidence. RESULTS We reviewed 1949 citations, from which we included 21 studies. The risk of bias for most of the included studies was moderate. A higher proportion of patients who received bisphosphonate achieved resolution of hypercalcemia when compared to placebo. The incidence rate of adverse events was significantly higher in the bisphosphonate group. Comparing denosumab to bisphosphonate, there was no significant difference in the rate of patients who achieved resolution of hypercalcemia. Two-thirds of patients with refractory/recurrent hypercalcemia of malignancy who received denosumab following bisphosphonate therapy achieved resolution of hypercalcemia. Addition of calcitonin to bisphosphonate therapy did not affect the resolution of hypercalcemia, time to normocalcemia, or hypocalcemia. Only indirect evidence was available to address questions on the management of hypercalcemia in tumors associated with high calcitriol levels, refractory/recurrent hypercalcemia of malignancy following the use of bisphosphonates, and the use of calcimimetics in the treatment of hypercalcemia associated with parathyroid carcinoma. The certainty of the evidence to address all 8 clinical questions was low to very low. CONCLUSION The evidence summarized in this systematic review addresses the benefits and harms of treatments of hypercalcemia of malignancy. Additional information about patients' values and preferences, and other important decisional and contextual factors is needed to facilitate the development of clinical recommendations.
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Affiliation(s)
- Mohamed O Seisa
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN 55902, USA
| | - Tarek Nayfeh
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN 55902, USA
| | - Bashar Hasan
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN 55902, USA
| | - Mohammed Firwana
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN 55902, USA
| | - Samer Saadi
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN 55902, USA
| | - Ahmed Mushannen
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN 55902, USA
| | - Sahrish H Shah
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN 55902, USA
| | - Noora S Rajjoub
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN 55902, USA
| | - Magdoleen H Farah
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN 55902, USA
| | | | - Zhen Wang
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN 55902, USA
| | - Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, American University of Beirut, Beirut, Lebanon
| | - Matthew T Drake
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Rochester, MN 55902, USA
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17
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El-Hajj Fuleihan G, Clines GA, Hu MI, Marcocci C, Murad MH, Piggott T, Van Poznak C, Wu JY, Drake MT. Treatment of Hypercalcemia of Malignancy in Adults: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2023; 108:507-528. [PMID: 36545746 DOI: 10.1210/clinem/dgac621] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hypercalcemia of malignancy (HCM) is the most common metabolic complication of malignancies, but its incidence may be declining due to potent chemotherapeutic agents. The high mortality associated with HCM has declined markedly due to the introduction of increasingly effective chemotherapeutic drugs. Despite the widespread availability of efficacious medications to treat HCM, evidence-based recommendations to manage this debilitating condition are lacking. OBJECTIVE To develop guidelines for the treatment of adults with HCM. METHODS A multidisciplinary panel of clinical experts, together with experts in systematic literature review, identified and prioritized 8 clinical questions related to the treatment of HCM in adult patients. The systematic reviews (SRs) queried electronic databases for studies relevant to the selected questions. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make recommendations. An independent SR was conducted in parallel to assess patients' and physicians' values and preferences, costs, resources needed, acceptability, feasibility, equity, and other domains relevant to the Evidence-to-Decision framework as well as to enable judgements and recommendations. RESULTS The panel recommends (strong recommendation) in adults with HCM treatment with denosumab (Dmab) or an intravenous (IV) bisphosphonate (BP). The following recommendations were based on low certainty of the evidence. The panel suggests (conditional recommendation) (1) in adults with HCM, the use of Dmab rather than an IV BP; (2) in adults with severe HCM, a combination of calcitonin and an IV BP or Dmab therapy as initial treatment; and (3) in adults with refractory/recurrent HCM despite treatment with BP, the use of Dmab. The panel suggests (conditional recommendation) the addition of an IV BP or Dmab in adult patients with hypercalcemia due to tumors associated with high calcitriol levels who are already receiving glucocorticoid therapy but continue to have severe or symptomatic HCM. The panel suggests (conditional recommendation) in adult patients with hypercalcemia due to parathyroid carcinoma, treatment with either a calcimimetic or an antiresorptive (IV BP or Dmab). The panel judges the treatments as probably accessible and feasible for most recommendations but noted variability in costs, resources required, and their impact on equity. CONCLUSIONS The panel's recommendations are based on currently available evidence considering the most important outcomes in HCM to patients and key stakeholders. Treatment of the primary malignancy is instrumental for controlling hypercalcemia and preventing its recurrence. The recommendations provide a framework for the medical management of adults with HCM and incorporate important decisional and contextual factors. The guidelines underscore current knowledge gaps that can be used to establish future research agendas.
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Affiliation(s)
| | - Gregory A Clines
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mimi I Hu
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56100, Italy
| | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Thomas Piggott
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, L8S 4K1, Canada
- MacGRADE Centre, McMaster University, Hamilton, ON, L8S 4K1, Canada
- Department of Family Medicine, Queens University, Kingston, ON, K7L 3G2, Canada
- Peterborough Public Health, Peterborough, ON, K9J 2R8, Canada
| | - Catherine Van Poznak
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Joy Y Wu
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Matthew T Drake
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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18
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Hollar DW. The competition of ecological resonances in the quantum metabolic model of cancer: Potential energetic interventions. Biosystems 2022; 222:104798. [DOI: 10.1016/j.biosystems.2022.104798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 11/02/2022]
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19
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Lewiecki EM, Bilezikian JP, Binkley N, Bouxsein ML, Bukata SV, Dempster DW, Drake MT, McClung MR, Miller PD, Rosenthal E, Tosi LL. Proceedings of the 2022 Santa Fe Bone Symposium: Current Concepts in the Care of Patients with Osteoporosis and Metabolic Bone Diseases. J Clin Densitom 2022; 25:649-667. [PMID: 36280582 DOI: 10.1016/j.jocd.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022]
Abstract
The 22nd Annual Santa Fe Bone Symposium (SFBS) was a hybrid meeting held August 5-6, 2022, with in-person and virtual attendees. Altogether, over 400 individuals registered, a majority of whom attended in-person, representing many states in the USA plus 7 other countries. The SFBS included 10 plenary presentations, 2 faculty panel discussions, satellite symposia, Bone Health & Osteoporosis Foundation Fracture Liaison Service Boot Camp, and a Project ECHO workshop, with lively interactive discussions for all events. Topics of interest included fracture prevention at different stages of life; how to treat and when to change therapy; skeletal health in cancer patients; advanced imaging to assess bone strength; the state of healthcare in the USA; osteosarcopenia; vitamin D update; perioperative bone health care; new guidelines for managing primary hyperparathyroidism; new concepts on bone modeling and remodeling; and an overview on the care of rare bone diseases, including hypophosphatasia, X-linked hypophosphatemia, tumor induced osteomalacia, osteogenesis imperfecta, fibrodysplasia ossificans progressiva, and osteopetrosis. The SFBS was preceded by the Santa Fe Fellows Workshop on Osteoporosis and Metabolic Bone Diseases, a collaboration of the Endocrine Fellows Foundation and the Osteoporosis Foundation of New Mexico. From the Workshop, 4 participating fellows were selected to give oral presentations at the bone symposium. These proceedings represent the clinical highlights of 2022 SFBS presentations and the discussions that followed, all with the aim of optimizing skeletal health and minimizing the consequences of fragile bones.
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Affiliation(s)
- E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA.
| | - John P Bilezikian
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Neil Binkley
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | | | - David W Dempster
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Michael R McClung
- Oregon Osteoporosis Center, Portland, OR, USA; Mary MacKillop Center for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Paul D Miller
- University of Colorado Health Sciences Center, Denver, CO, USA
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20
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Guise TA, Wysolmerski JJ. Cancer-Associated Hypercalcemia. Reply. N Engl J Med 2022; 386:2540. [PMID: 35767456 DOI: 10.1056/nejmc2206287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Theresa A Guise
- University of Texas M.D. Anderson Cancer Center, Houston, TX
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