1
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Lakhal M, Kebbara S, Thouil A, Kouismi H. Malignant Hypercalcemia Revealing Pulmonary Sarcoidosis. Cureus 2024; 16:e64454. [PMID: 39135824 PMCID: PMC11318219 DOI: 10.7759/cureus.64454] [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: 07/13/2024] [Indexed: 08/15/2024] Open
Abstract
Sarcoidosis is a systemic disorder characterized by the development of granulomatous inflammation in various organs of the body. Hypercalcemia is one of its manifestations. We present a case of malignant hypercalcemia in a 77-year-old man, diagnosed as sarcoidosis following multiple assessments and histological confirmation showing noncaseating granulomas. In the absence of an etiological diagnosis, treatment was initially based on hydration, diuretics, and bisphosphonate. Glucocorticoid therapy can be the standard treatment for hypercalcemia related to sarcoidosis.
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Affiliation(s)
- Mohamed Lakhal
- Department of Respiratory Diseases, Research, and Medical Sciences Laboratory, Mohammed VI University Hospital, Oujda, MAR
| | - Salaheddine Kebbara
- Department of Respiratory Diseases, Research, and Medical Sciences Laboratory, Mohammed VI University Hospital, Oujda, MAR
| | - Afaf Thouil
- Department of Respiratory Diseases, Research, and Medical Sciences Laboratory, Mohammed VI University Hospital, Oujda, MAR
| | - Hatim Kouismi
- Department of Respiratory Diseases, Research, and Medical Sciences Laboratory, Mohammed VI University Hospital, Oujda, MAR
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2
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Kilci F, Jones JH, Çizmecioğlu-Jones FM. Successful Management of Severe Hypercalcemia with Zoledronic Acid: A Report of Two Pediatric Cases. J Clin Res Pediatr Endocrinol 2024; 16:224-228. [PMID: 36264042 DOI: 10.4274/jcrpe.galenos.2022.2022-9-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Severe hypercalcemia associated with vitamin D intoxication or malignancy in children is a rare and life-threatening condition. There is little published experience with Zoledronic acid (ZA) in the treatment of pediatric severe hypercalcemia. Here, we present two pediatric cases of severe hypercalcemia, one due to vitamin D intoxication and the second to malignancy, in which ZA was used as the first-line bisphosphonate in the treatment. While both cases responded well to a single dose of ZA, the second case experienced hypocalcemia requiring calcium treatment after ZA infusion. Our report shows that ZA may be an effective option in the treatment of severe pediatric hypercalcemia, although patients should be followed closely after infusion due to the risk of hypocalcemia. We provide additional published evidence for the effectiveness of ZA in correcting severe pediatric hypercalcemia and hope this will encourage future studies with larger numbers of patients.
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Affiliation(s)
- Fatih Kilci
- Kocaeli University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Kocaeli, Turkey
| | - Jeremy Huw Jones
- Kocaeli University, Department of Academic Writing, Kocaeli, Turkey
| | - Filiz Mine Çizmecioğlu-Jones
- Kocaeli University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Kocaeli, Turkey
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3
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Martín MJ, Maury Fuentes K, Novoa Díaz MB, Cao G, Gigola G, Brunetto O, Gentili C. Severe hypercalcaemia in an infant. J Clin Pathol 2021; 74:jclinpath-2020-206697. [PMID: 33858939 DOI: 10.1136/jclinpath-2020-206697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 12/17/2020] [Accepted: 12/27/2020] [Indexed: 11/03/2022]
Affiliation(s)
- María Julia Martín
- INBIOSUR, Departamento de Biología, Bioquímica y Farmacia, Universidad Nacional del Sur (UNS)-CONICET, Bahía Blanca, Argentina
| | - Kelly Maury Fuentes
- División Endocrinología, Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina
| | - María Belén Novoa Díaz
- INBIOSUR, Departamento de Biología, Bioquímica y Farmacia, Universidad Nacional del Sur (UNS)-CONICET, Bahía Blanca, Argentina
| | - Gabriel Cao
- División Endocrinología, Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina
| | - Graciela Gigola
- INBIOSUR, Departamento de Biología, Bioquímica y Farmacia, Universidad Nacional del Sur (UNS)-CONICET, Bahía Blanca, Argentina
| | - Oscar Brunetto
- División Endocrinología, Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina
| | - Claudia Gentili
- INBIOSUR, Departamento de Biología, Bioquímica y Farmacia, Universidad Nacional del Sur (UNS)-CONICET, Bahía Blanca, Argentina
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4
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Hand Mirror Cells and Hypercalcemia: A Rare Presentation of Pediatric Acute Lymphoblastic Leukemia. J Pediatr Hematol Oncol 2020; 42:e181-e184. [PMID: 30475304 DOI: 10.1097/mph.0000000000001352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hand mirror cell (HMC) leukemia is a variant of acute lymphoblastic leukemia previously described in the adult population where lymphoblasts manifest distinctive hand mirror morphologic features. HMC has been previously identified in 23% of childhood acute lymphoblastic leukemia patients, but its prognostic significance in children is not well understood. Hypercalcemia is also uncommon in childhood leukemias. Hypercalcemia associated with HMC leukemia has not been previously reported. We report a 5-year-old boy with HMC B-lymphoblastic leukemia who presented with hypercalcemia.
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5
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Bota M, Popa G, Neaga A, Gocan H, Blag CL. Acute Lymphoblastic Leukemia with Malignant Hypercalcemia: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:402-405. [PMID: 30918242 PMCID: PMC6452782 DOI: 10.12659/ajcr.914303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Patient: Female, 6 Final Diagnosis: Acute lymphoblastic leukemia Symptoms: Abdominal pain • bloody diarrhea • malaise • vomiting Medication: — Clinical Procedure: Chemotherapy Specialty: Oncology
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Affiliation(s)
- Mădălina Bota
- Department of Pediatrics, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Gheorghe Popa
- Department of Pediatrics, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Alexandra Neaga
- Department of Pediatrics, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Horatiu Gocan
- Department of Pediatric Surgery and Orthopedics, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Cristina Lucia Blag
- Department of Pediatrics, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
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6
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Simm PJ, Biggin A, Zacharin MR, Rodda CP, Tham E, Siafarikas A, Jefferies C, Hofman PL, Jensen DE, Woodhead H, Brown J, Wheeler BJ, Brookes D, Lafferty A, Munns CF. Consensus guidelines on the use of bisphosphonate therapy in children and adolescents. J Paediatr Child Health 2018; 54:223-233. [PMID: 29504223 DOI: 10.1111/jpc.13768] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/28/2017] [Accepted: 08/17/2017] [Indexed: 12/21/2022]
Abstract
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). The use of bisphosphonates in non-fragility conditions, such as fibrous dysplasia, avascular necrosis, bone cysts and hypercalcaemia, is also discussed. While these guidelines provide an evidence-based approach where possible, further research is required in all clinical applications in order to strengthen the recommendations made.
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Affiliation(s)
- Peter J Simm
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Biggin
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Margaret R Zacharin
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Christine P Rodda
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Australian Institute for Musculoskeletal Research, Sunshine Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Sunshine Hospital, Melbourne, Victoria, Australia
| | - Elaine Tham
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Aris Siafarikas
- Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Craig Jefferies
- Department of Endocrinology and Diabetes, Starship Children's Health, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Diane E Jensen
- Children's Health Queensland, Hospital and Health Services District, South Brisbane, Queensland, Australia.,Centre for Children's Health Research, University of Queensland, Brisbane, Queensland, Australia
| | - Helen Woodhead
- Department of Endocrinology and Diabetes, Sydney Children's Hospital, Sydney, New South Wales, Australia.,Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Justin Brown
- Department of Paediatric Endocrinology, Monash Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Benjamin J Wheeler
- Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Denise Brookes
- Centre for Children's Health Research, University of Queensland, Brisbane, Queensland, Australia
| | - Antony Lafferty
- Department of Paediatrics, Canberra Hospital, Canberra, Australian Capital Territory, Australia.,Department of Paediatrics and Child Health, Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Craig F Munns
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
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7
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Brooks R, Lord C, Davies JH, Gray JC. Hypercalcaemia secondary to ectopic parathyroid hormone expression in an adolescent with metastatic alveolar rhabdomyosarcoma. Pediatr Blood Cancer 2018; 65. [PMID: 28843052 DOI: 10.1002/pbc.26778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 07/27/2017] [Accepted: 07/31/2017] [Indexed: 11/06/2022]
Abstract
We report the case of a 14-year-old male with metastatic alveolar rhabdomyosarcoma, presenting with hypercalcaemia (3.89 mmol/l) and elevated parathyroid hormone (PTH) level (10.2 pmol/l). Imaging demonstrated extensive bony lytic damage, with "floating teeth" in the mandible. Normalisation of calcium levels and bony reformation of the mandible occurred following chemotherapy; PTH levels decreased initially but remained above normal levels. Imaging did not demonstrate any evidence of parathyroid abnormality. Tumour ectopic PTH secretion is a very rare cause of hypercalcaemia of malignancy in children. Hypercalcaemia with an elevated PTH, in the absence of parathyroid-related cause, should prompt investigation for underlying malignancy.
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Affiliation(s)
- Rachael Brooks
- Department of Paediatric Oncology, University Hospital Southampton Foundation Trust, Southampton, UK
| | - Christopher Lord
- Department of Paediatric Radiology, University Hospital Southampton Foundation Trust, Southampton, UK
| | - Justin H Davies
- Department of Paediatric Endocrinology, University Hospital Southampton Foundation Trust, Southampton, UK
| | - Juliet C Gray
- Department of Paediatric Oncology, University Hospital Southampton Foundation Trust, Southampton, UK.,Cancer Sciences Unit, University of Southampton, Southampton, UK
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8
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Chang TY, Jaing TH, Chen SH. Treatment of critical hypercalcemia using pamidronate in acute megakaryoblastic leukemia in an 18-month-old girl. Pediatr Neonatol 2017; 58:462-464. [PMID: 28427853 DOI: 10.1016/j.pedneo.2016.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/22/2016] [Accepted: 09/12/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- Tsung-Yen Chang
- Division of Hematology/Oncology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Tang-Her Jaing
- Division of Hematology/Oncology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shih-Hsiang Chen
- Division of Hematology/Oncology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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9
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Hirschfeld R, Welch JJG, Harrison DJ, Kremsdorf R, Chawla A. Two cases of humoral hypercalcemia of malignancy complicating infantile fibrosarcoma. Pediatr Blood Cancer 2017; 64. [PMID: 28371408 DOI: 10.1002/pbc.26511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 11/09/2022]
Abstract
We report two infants with infantile fibrosarcoma (IFS) complicated by severe hypercalcemia. Assessment demonstrated suppressed parathyroid hormone and 1,25-dihydroxyvitamin D levels with elevated circulating levels of parathyroid hormone related protein, indicating the diagnosis of humoral hypercalcemia of malignancy (HHM). HHM is a paraneoplastic syndrome rarely associated with pediatric malignancies. Hypercalcemia manifested clinically with neurologic symptoms and soft tissue calcium deposition and required aggressive management with intravenous fluids, diuretics, and supplemental electrolytes. Following treatment with neoadjuvant chemotherapy, serum calcium levels precipitously declined requiring calcium repletion. These cases highlight the improvement of hypercalcemia secondary to HHM following chemotherapy.
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Affiliation(s)
- Ryan Hirschfeld
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jennifer J G Welch
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Douglas J Harrison
- Division of Pediatrics, Department of Pediatric Care, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robin Kremsdorf
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Anjulika Chawla
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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10
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Hoyoux C, Lombet J, Nicolescu CR. Malignancy-Induced Hypercalcemia-Diagnostic Challenges. Front Pediatr 2017; 5:233. [PMID: 29181374 PMCID: PMC5693871 DOI: 10.3389/fped.2017.00233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 10/17/2017] [Indexed: 12/25/2022] Open
Abstract
Hypercalcemia in children is a rare metabolic finding. The clinical picture is usually non-specific, and the etiology includes several entities (metabolic, nutritional, drug-induced, inflammatory, cancer-associated, or genetic) depending on the age at presentation, but severe hypercalcemia is associated mainly with malignancy in childhood and sepsis in neonates. Severe parathyroid hormone (PTH)-suppressed hypercalcemia is challenging and requires multidisciplinary diagnostic and therapeutic approaches to (i) confirm or rule out a malignant cause, (ii) treat it and its potentially dangerous complications. We report a case of severe and complicated PTH-independent hypercalcemia in a symptomatic 3-year-old boy. His age, severity of hypercalcemia and its complicated course, and the first imaging reports were suggestive of malignancy. The first bone and kidney biopsies and bone marrow aspiration were normal. The definitive diagnosis was a malignant-induced hypercalcemia, and we needed 4 weeks to assess other differential diagnoses and to confirm, on histopathological and immunochemical base, the malignant origin of hypercalcemia. Using this case as an illustrative example, we suggest a diagnostic approach that underlines the importance of repeated histology if the clinical suspicion is malignancy-induced hypercalcemia. Effective treatment is required acutely to restore calcium levels and to avoid complications.
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Affiliation(s)
- Claire Hoyoux
- Department of Pediatric Hematology and Oncology, Centre Hospitalier Regional de la Citadelle, University of Liège, Liège, Belgium
| | - Jacques Lombet
- Department of Pediatric Nephrology, Centre Hospitalier Regional de la Citadelle, University of Liège, Liège, Belgium
| | - Corina Ramona Nicolescu
- Department of Pediatric Endocrinology, Centre Hospitalier Regional de la Citadelle, University of Liège, Liège, Belgium
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11
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Martins AL, Moniz M, Nunes PS, Abadesso C, Loureiro HC, Duarte X, Almeida HI. Severe hypercalcemia as a form of acute lymphoblastic leukemia presentation in children. Rev Bras Ter Intensiva 2016; 27:402-5. [PMID: 26761480 PMCID: PMC4738828 DOI: 10.5935/0103-507x.20150067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 11/19/2015] [Indexed: 11/20/2022] Open
Abstract
Hypercalcemia is a rare metabolic disorder in children and is potentially fatal. It has a wide differential diagnosis, including cancer. Here, we report the case of a previously healthy 3-year-old who was admitted to the emergency room with fatigue, hyporeactivity, fever and limping gait that had evolved over 5 days and that was progressively worsening. On examination the patient was unconscious (Glasgow coma score: 8). Laboratory tests indicated severe hypercalcemia (total calcium 21.39mg/dL, ionized calcium 2.93mmol/L) and microcytic anemia. Hyperhydration was initiated, and the child was transferred to the pediatric intensive care unit. Continuous venovenous hemodiafiltration with calcium-free solution was instituted, which brought progressive normalization of serum calcium and an improved state of consciousness. Zoledronate was administered, and metabolic and infectious causes and poisoning were excluded. The bone marrow smear revealed a diagnosis of acute lymphoblastic leukemia. Hypercalcemia associated with malignancy in children is rare and occurs as a form of cancer presentation or recurrence. Continuous venovenous hemodiafiltration should be considered in situations where there is imminent risk to life.
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Affiliation(s)
- Andreia Luís Martins
- Unidade de Cuidados Intensivos Pediátricos, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Marta Moniz
- Unidade de Cuidados Intensivos Pediátricos, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Pedro Sampaio Nunes
- Unidade de Cuidados Intensivos Pediátricos, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Clara Abadesso
- Unidade de Cuidados Intensivos Pediátricos, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Helena Cristina Loureiro
- Unidade de Cuidados Intensivos Pediátricos, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Ximo Duarte
- Departamento de Oncologia da Criança e Adolescente, Instituto Português de Oncologia Lisboa, Lisboa, Portugal
| | - Helena Isabel Almeida
- Unidade de Cuidados Intensivos Pediátricos, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
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12
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Alsaied T, Mohameden M, Lee L, Lawson SA, Mantell BS, Saqr AH, Nagarajan R. Abdominal Pain, Fatigue, and Constipation in a Teenager Female: Is It Worth Further Investigations? Clin Pediatr (Phila) 2016; 55:986-9. [PMID: 26581356 DOI: 10.1177/0009922815616071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Tarek Alsaied
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Lynn Lee
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sarah A Lawson
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Ahmad H Saqr
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
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13
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Gastanaga VM, Schwartzberg LS, Jain RK, Pirolli M, Quach D, Quigley JM, Mu G, Scott Stryker W, Liede A. Prevalence of hypercalcemia among cancer patients in the United States. Cancer Med 2016; 5:2091-100. [PMID: 27263488 PMCID: PMC4899051 DOI: 10.1002/cam4.749] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 03/04/2016] [Accepted: 03/16/2016] [Indexed: 12/11/2022] Open
Abstract
Hypercalcemia of malignancy (HCM) is a serious metabolic complication whose population‐based prevalence has not been quantified. Rates of HCM differ by tumor type, with highest rates reported in multiple myeloma and lowest among colorectal and prostate cancer patients. This analysis estimates HCM prevalence in the US. This retrospective study used the Oncology Services Comprehensive Electronic Records (OSCER) warehouse of electronic health records (EHR) including laboratory values from 569000 patients treated at 565 oncology outpatient sites. OSCER data were projected to the national level by linking EHR to claims data. Cancer patients included were ≥18 years, and had serum calcium (Ca) and albumin (for corrected serum Ca [CSC]) records. Period prevalence was estimated by HCM CTCAE grade, tumor type, and year (2009–2013). Estimates were adjusted to capture patients diagnosed with HCM outside oncology practices based on a subset of patients linkable to office and hospital data. The analysis included 68023 (2009) to 121482 (2013) cancer patients. In 2013, patients with HCM had a median of six Ca tests, 69.7% had chemotherapy, and 34% received bone modifying agents. HCM rates were highest for multiple myeloma patients (7.5% [2012]–10.2% [2010]), lowest for prostate cancer (1.4% [2012]–2.1% [2011]).The estimated adjusted annual prevalence of HCM from 2009 to 2013 was 95441, 96281, 89797, 70158, and 71744, respectively. HCM affected 2.0–2.8% of all cancer patients. EHR data from oncology clinics were critical for this study because these data contain results from laboratory studies (i.e., serum calcium values) that are routinely ordered in that setting. We estimated that the prevalence of HCM in the US in 2013 is 71744, affecting approximately 2% of cancer patients overall. This percentage differs by tumor type and appears to have decreased over the five‐year study period.
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Affiliation(s)
| | | | | | | | - David Quach
- PRA Health Sciences, Blue Bell, Pennsylvania
| | | | - George Mu
- Glaxo Smith Kline, Collegeville, Pennsylvania
| | - W Scott Stryker
- Amgen Inc., Thousand Oaks and South San Francisco, California
| | - Alexander Liede
- Amgen Inc., Thousand Oaks and South San Francisco, California
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14
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Park HJ, Choi EJ, Kim JK. A successful treatment of hypercalcemia with zoledronic acid in a 15-year-old boy with acute lymphoblastic leukemia. Ann Pediatr Endocrinol Metab 2016; 21:99-104. [PMID: 27462588 PMCID: PMC4960023 DOI: 10.6065/apem.2016.21.2.99] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/18/2016] [Accepted: 05/24/2016] [Indexed: 11/20/2022] Open
Abstract
Severe hypercalcemia in children is a rare medical emergency. We present a case of a 15-year-old boy with hypercalcemia (total calcium level, 14.2 mg/dL) with a normal complete blood count, no circulating blasts in the peripheral blood film, and no other signs of acute lymphoblastic leukemia (ALL), including no signs of lymphadenopathy or hepatosplenomegaly. The hypercalcemia was successfully treated with zoledronic acid. As hypercalcemia can be the only presenting symptom of ALL in children, the diagnosis is often delayed. In children presenting with hypercalcemia, malignancies must be considered in the differential diagnosis.
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Affiliation(s)
- Hye-Jin Park
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Eun-Jin Choi
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jin-Kyung Kim
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea
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15
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Carachi R, Grosfeld JL. Surgical Complications of Childhood Tumors. THE SURGERY OF CHILDHOOD TUMORS 2016. [PMCID: PMC7121030 DOI: 10.1007/978-3-662-48590-3_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Robert Carachi
- Surgical Paediatrics, University of Glasgow, Glasgow, United Kingdom
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16
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Gill RK, Smith ZJ, Panchal RR, Bishop JW, Gandour-Edwards R, Wachsmann-Hogiu S. Preliminary fsLIBS study on bone tumors. BIOMEDICAL OPTICS EXPRESS 2015; 6:4850-4858. [PMID: 26713199 PMCID: PMC4679259 DOI: 10.1364/boe.6.004850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/28/2015] [Accepted: 11/10/2015] [Indexed: 06/05/2023]
Abstract
The aim of this study is to evaluate the capability of femtosecond Laser Induced Breakdown Spectroscopy (fsLIBS) to discriminate between normal and cancerous bone, with implications to femtosecond laser surgery procedures. The main advantage of using femtosecond lasers for surgery is that the same laser that is being used to ablate can also be used for a feedback system to prevent ablation of certain tissues. For bone tumor removal, this technique has the potential to reduce the number of repeat surgeries that currently must be performed due to incomplete removal of the tumor mass. In this paper, we performed fsLIBS on primary bone tumor, secondary tumor in bone, and normal bone. These tissues were excised from consenting patients and processed through the UC Davis Cancer Center Biorepository. For comparison, each tumor sample had a matched normal bone sample. fsLIBS was performed to characterize the spectral signatures of each tissue type. A minimum of 20 spectra were acquired for each sample. We did not detect significant differences between the fsLIBS spectra of secondary bone tumors and their matched normal bone samples, likely due to the heterogeneous nature of secondary bone tumors, with normal and cancerous tissue intermingling. However, we did observe an increase in the fsLIBS magnesium peak intensity relative to the calcium peak intensity for the primary bone tumor samples compared to the normal bone samples. These results show the potential of using femtosecond lasers for both ablation and a real-time feedback control system for treatment of primary bone tumors.
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Affiliation(s)
- Ruby K Gill
- Center for Biophotonics, University of California, Davis, 95616, USA ; Department of Biomedical Engineering, University of California, Davis, 95616, USA ; These authors contributed equally to this work
| | - Zachary J Smith
- Center for Biophotonics, University of California, Davis, 95616, USA ; Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, Anhui, China ; These authors contributed equally to this work
| | - Ripul R Panchal
- Department of Neurological Surgery, University of California, Davis, 95616, USA
| | - John W Bishop
- Department of Pathology and Laboratory Medicine, University of California, Davis, 95616, USA
| | - Regina Gandour-Edwards
- Department of Pathology and Laboratory Medicine, University of California, Davis, 95616, USA
| | - Sebastian Wachsmann-Hogiu
- Center for Biophotonics, University of California, Davis, 95616, USA ; Department of Pathology and Laboratory Medicine, University of California, Davis, 95616, USA ; These authors contributed equally to this work ;
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Metastatic Calcinosis Cutis: A Case in a Child with Acute Pre-B Cell Lymphoblastic Leukemia. Case Rep Hematol 2015; 2015:384821. [PMID: 26346120 PMCID: PMC4540989 DOI: 10.1155/2015/384821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/20/2015] [Accepted: 07/28/2015] [Indexed: 11/17/2022] Open
Abstract
Hypercalcemia in children with malignancy is an uncommon condition. It has been described in leukemia patients with impaired renal excretion of calcium or osteolytic lesions. Metastatic calcinosis cutis (MCC) may develop if hypercalcemia persists. We report the case of a 5-year-old girl with an atypical dermatosis and unspecific gastrointestinal symptoms. Considered clinical diagnoses were xanthomas, histiocytosis, molluscum contagiosum, and nongenital warts. Cutaneous histological analysis showed amorphous basophilic deposits in the dermis suggestive of calcium deposits. Laboratory tests confirmed serum hypercalcemia. Extensive investigations such as bone marrow biopsy established the diagnosis of an acute pre-B cell lymphoblastic leukemia. Hypercalcemia in hematopoietic malignancies is unusual, especially as initial manifestation of the disease. Careful review of the literature fails to reveal previous reports of these peculiar cutaneous lesions of MCC in children with leukemia.
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Predicting, Monitoring, and Managing Hypercalcemia Secondary to 13-Cis-Retinoic Acid Therapy in Children With High-risk Neuroblastoma. J Pediatr Hematol Oncol 2015; 37:477-81. [PMID: 26056798 DOI: 10.1097/mph.0000000000000362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
13-cis-retinoic acid is an established component of treatment for children with high-risk neuroblastoma. However, significant hypercalcemia is increasingly recognized as a potentially life-threatening dosage-related side effect. We present 2 patients with significant hypercalcemia secondary to 13-cis-retinoic acid and their management, and identified the predictive factors for susceptibility to hypercalcemia. Assessing glomerular filtration rate and concomitant medication help predict individual susceptibility to hypercalcemia. Calcium levels should be monitored at days 1, 7, and 14 of each course of retinoic acid. An algorithm for the management of hypercalcemia during the affected and subsequent cycles of retinoid therapy is proposed.
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Fisher MM, Misurac JM, Leiser JD, Walvoord EC. Extreme Hypercalcemia of Malignancy in a Pediatric Patient: Therapeutic Considerations. AACE Clin Case Rep 2015. [DOI: 10.4158/ep14308.cr] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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20
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Kolyva S, Efthymiadou A, Gkentzi D, Karana-Ginopoulou A, Varvarigou A. Hypercalcemia and osteolytic lesions as presenting symptoms of acute lymphoblastic leukemia in childhood. The use of zoledronic acid and review of the literature. J Pediatr Endocrinol Metab 2014; 27:349-54. [PMID: 23934636 DOI: 10.1515/jpem-2013-0244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 07/15/2013] [Indexed: 11/15/2022]
Abstract
Hypercalcemia is rare in children with etiology different from adults. We report an 11.5-year-old boy with developmental delay that presented with difficulty in walking and vomiting. Laboratory investigations revealed hypercalcemia (Ca 13.8 mg/dL) with low serum parathormone, normal full blood count and no circulating blasts. Osteolytic lesions were discovered on radiological survey. Bone marrow examination was consistent with the diagnosis of common B acute lymphoblastic leukemia (ALL). Hypercalcemia was successfully treated with zoledronic acid. Hypercalcemia is a rare but well-recognized complication of ALL, usually present at the time of initial diagnosis. We reviewed the literature and analyzed the clinical and laboratory data in 36 cases of childhood ALL presenting with hypercalcemia. In conclusion, hypercalcemia alone or combined with osteolytic lesions can be the only presenting symptom of ALL in children.
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Otsubo K, Nomura K, Miyawaki T, Kanegane H. Nocturnal enuresis as a first manifestation of acute lymphoblastic leukemia. Pediatr Int 2013; 55:126-7. [PMID: 23409995 DOI: 10.1111/ped.12038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 10/22/2012] [Accepted: 12/17/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Keisuke Otsubo
- Department of Pediatrics; Graduate School of Medicine and Pharmaceutical Sciences; University of Toyama; Toyama; Japan
| | - Keiko Nomura
- Department of Pediatrics; Graduate School of Medicine and Pharmaceutical Sciences; University of Toyama; Toyama; Japan
| | - Toshio Miyawaki
- Department of Pediatrics; Graduate School of Medicine and Pharmaceutical Sciences; University of Toyama; Toyama; Japan
| | - Hirokazu Kanegane
- Department of Pediatrics; Graduate School of Medicine and Pharmaceutical Sciences; University of Toyama; Toyama; Japan
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Abstract
We report a 3-year old boy with acute onset of left sided facial palsy secondary to tick infestation in the left ear. On 7th day of follow-up, following tick removal, the facial palsy had resolved.
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Jawaid W, Solari V, Howell L, Jesudason E. Excision of extensive metastatic dysgerminoma to control refractory hypercalcaemia in a child at high risk for tumour-lysis syndrome. J Pediatr Surg 2011; 46:e13-9. [PMID: 21238625 DOI: 10.1016/j.jpedsurg.2010.08.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 08/19/2010] [Accepted: 08/23/2010] [Indexed: 10/18/2022]
Abstract
Hypercalcaemia is a rare life-threatening complication of paediatric cancer that is commoner in haematological than solid malignancies and associated rarely with acute renal failure. Often refractory to medical therapy, control of hypercalcaemia in children with solid tumours may necessitate excision of localised tumours or urgent chemotherapy for metastatic ones. We present a child with refractory hypercalcaemia, bulky chemosensitive metastatic tumours and acute renal failure in whom chemotherapy posed high-risk of tumour lysis syndrome (TLS). Resection of the metastatic tumours successfully normalised the hypercalcaemia and represents a practical alternative control strategy in cases at high risk of TLS.
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Affiliation(s)
- Wajid Jawaid
- Division of Child Health, University of Liverpool, Liverpool L12 2AP, UK
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An instructive case of hypercalcemia preceding relapse of AML following allogeneic BMT. Bone Marrow Transplant 2010; 46:1028-9. [PMID: 20921940 DOI: 10.1038/bmt.2010.228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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25
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Sargent JTS, Smith OP. Haematological emergencies managing hypercalcaemia in adults and children with haematological disorders. Br J Haematol 2010; 149:465-77. [PMID: 20377591 DOI: 10.1111/j.1365-2141.2010.08173.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Hypercalcaemia is a common metabolic complication of malignant disease often requiring emergency intervention. Although it is more frequently associated with solid tumours, malignancy-associated hypercalcaemia (MAH) is seen in a significant number of patients with blood diseases. Its association with myeloma and adult T-cell leukaemia/lymphoma is well recognized but the incidence of hypercalcaemia in other haematological neoplasms, affecting adults and children, is less clearly defined. Haematologists need to be familiar with the clinical manifestations of, the differential diagnosis to be considered and the most effective management strategies that are currently available for MAH. The key components of management of MAH include aggressive rehydration, specific therapy to inhibit bone resorption and, crucially, treatment of the underlying malignancy. Bisphosphonates have revolutionized the management of MAH over the last 20 years, however the elucidation of molecular pathways implicated in MAH is facilitating the development of more targeted approaches to treatment.
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Affiliation(s)
- Jeremy T S Sargent
- Trinity College, and Department of Haematology & Oncology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
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Hypercalcemia in pediatric acute megakaryocytic leukemia: case report and review of the literature. J Pediatr Hematol Oncol 2009; 31:373-6. [PMID: 19415024 DOI: 10.1097/mph.0b013e31819a5d29] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hypercalcemia has been described as a possible complication of many pediatric malignancies. Here, we report an 8-month-old non-Down syndrome infant with acute megakaryocytic leukemia and severe hypercalcemia at presentation. A review of the literature reveals that this is the first case of hypercalcemia complicating acute megakaryocytic leukemia reported in the pediatric literature. His initial workup, and the course of management and outcome, is described in detail. Though the etiology of this complication remains unclear, our experience suggests that early institution of chemotherapy along with supportive care is the best treatment for control of hypercalcemia.
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27
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Reversal of hypercalcemic acute kidney injury by treatment with intravenous bisphosphonates. Pediatr Nephrol 2009; 24:613-7. [PMID: 18839218 DOI: 10.1007/s00467-008-1011-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 08/20/2008] [Accepted: 08/23/2008] [Indexed: 10/21/2022]
Abstract
We present the details of three children with hypercalcemia-induced acute kidney injury (AKI). After traditional therapy with fluids, loop diuretics, steroids and calcitonin had failed to correct the hypercalcemia, they were given treatment with low doses of intravenous (i.v.) pamidronate, which resulted in normalization of serum calcium and kidney function. In one child Doppler renal ultrasound revealed dampened arterial blood flow, which resolved with normalization of serum calcium. On the basis of cumulative data and our experience, we suggest that i.v. application of bisphosphonates be moved from the second to the first line of treatment of hypercalcemic AKI.
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Surgical Complications of Childhood Tumors. THE SURGERY OF CHILDHOOD TUMORS 2008. [PMCID: PMC7122594 DOI: 10.1007/978-3-540-29734-5_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Most childhood tumors will first present to a physician; some tumors will present in an atypical manner and may mimic a surgical condition. The diagnosis may be missed if the surgeon is not aware of the possibility of cancer. A very great number of rare presentations of childhood cancer have been described in the literature. It is important that the surgeon who is not experienced in the management of childhood cancer is aware that an apparently benign condition could be a manifestation of an underlying malignancy [71, 83] (Table 22.1).
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Chatterjee M, Speiser PW. Pamidronate treatment of hypercalcemia caused by vitamin D toxicity. J Pediatr Endocrinol Metab 2007; 20:1241-8. [PMID: 18183797 DOI: 10.1515/jpem.2007.20.11.1241] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We present a 16 month-old previously healthy boy with refractory hypercalcemia due to an overdose of an over-the-counter vitamin supplement. The patient presented to the emergency department with a few weeks' history of irritability, constipation and intermittent vomiting. His serum calcium was found to be 18 mg/dl. He was first treated with intravenous fluids, furosemide and glucocorticoids without significant improvement, but became eucalcemic within 24 hours after receiving a single dose of pamidronate. This case highlights the potential danger of high dose vitamin supplements in children, and the salutary effects of treatment with bisphosphonate.
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Affiliation(s)
- Manjula Chatterjee
- Division of Pediatric Endocrinology, Schneider Children's Hospital, New Hyde Park, NY 11040, USA.
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Abstract
CASE An 8-year-old girl presented to the emergency department with a history of nausea, vomiting, abdominal pain, tiredness, and weight loss of 18 lb over 3 weeks. The only significant examination finding was moderate dehydration. She was found to have severe hypercalcemia (serum calcium, 20 mg/dL). The complete blood count was normal. She was treated successfully for hypercalcemia with hyperhydration, furosemide, calcitonin, and pamidronate. A few days later, she developed pancytopenia when her bone marrow biopsy specimen established the diagnosis of acute lymphoblastic leukemia. CONCLUSIONS Hypercalcemia presents with nonspecific symptoms of nausea, vomiting, pain in the abdomen, constipation, and tiredness. It can be a harbinger of acute lymphoblastic leukemia. Normal complete blood cell count at presentation does not exclude the diagnosis of leukemia.
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Affiliation(s)
- Manoj K Mittal
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104-4318, USA.
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Mastrandrea LD, Albini CH. Bisphosphonate Treatment of Tumor-Induced Hypercalcemia in a Toddler: Case Report and Review of Related Literature. Endocr Pract 2006; 12:670-5. [PMID: 17229665 DOI: 10.4158/ep.12.6.670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the initial manifestations and treatment of parathyroid hormone-related peptide (PTH-rP)-induced hypercalcemia in a toddler with a malignant rhabdoid tumor. METHODS We report a case of a 2-year-old boy presenting with poor appetite, lethargy, and a 1.5-kg weight loss during a 2-week period. On examination, the child was found to have a right upper quadrant abdominal mass. Laboratory studies revealed severe hypercalcemia. We review the patients' clinical course and management of hypercalcemia. RESULTS Initial evaluation revealed no cardiovascular instability. An abdominal mass was identified on physical examination. Initial laboratory studies revealed elevated levels of total and ionized calcium, low phosphorus, microcytic anemia, and elevated erythrocyte sedimentation rate. Saline diuresis with furosemide was begun. Abdominal ultrasonography revealed a large right renal tumor. Because of refractory hypercalcemia, intravenously administered bisphosphonate was used. Within 12 hours after bisphosphonate infusion, the serum calcium level declined from 14.9 mg/dL to 10.9 mg/dL. The furosemide dose was decreased and finally discontinued 2 days after bisphosphonate administration. Because of development of a femoral thrombosis, definitive surgical intervention was delayed. During that time, serum calcium levels again increased and necessitated administration of a second bisphosphonate dose. At surgical treatment, a right renal tumor was identified, and frozen section pathology revealed a rhabdoid tumor. After tumor resection, calcium levels were stable. Other laboratory studies performed at admission revealed suppressed PTH, normal vitamin D and calcitonin levels, and elevated PTH-rP. CONCLUSION Hypercalcemia in a toddler is a rare event and can be attributable to humoral factors released by malignant tumors. Hypercalcemia in the pediatric population can be treated effectively with bisphosphonates when conservative measures fail.
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Affiliation(s)
- Lucy D Mastrandrea
- Division of Pediatric Endocrinology, Women's and Children's Hospital of Buffalo, The State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, New York 14222, USA
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Abstract
Hypercalcemia is a rare complication of pediatric malignant germ cell tumors. The problem may be missed because of unawareness among pediatric oncologists. We describe a 16-year-old girl with an ovarian dysgerminoma associated with severe hypercalcemia, a metabolic abnormality infrequently reported with this disease. We review some of the potential causes of malignancy-associated hypercalcemia and current treatment strategies. It is our recommendation that calcium levels should be monitored in all children with solid ovarian masses. Hypercalcemia seen in these situations may not improve until the tumor is removed.
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Affiliation(s)
- Richardson Matthew
- Department of Pediatrics, Section of Pediatric Hematology/Oncology, Baystate Medical Center Children's Hospital, Springfield, Massachusetts 01107, USA.
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Atabek ME, Pirgon O, Sert A. Oral alendronate therapy for severe vitamin D intoxication of the infant with nephrocalcinosis. J Pediatr Endocrinol Metab 2006; 19:169-72. [PMID: 16562591 DOI: 10.1515/jpem.2006.19.2.169] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Vitamin D intoxication is a well-known cause of hypercalcemia in children. We report here the use of oral alendronate for the treatment of hypercalcemia due to vitamin D intoxication in a 7 month-old infant with nephrocalcinosis. The serum calcium levels were normalized without complications. Oral alendronate therapy may be safely used in hypercalcemia due to vitamin. D intoxication in pediatric patients with nephrocalcinosis resistant to hydration, diuretics or corticosteroids.
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Affiliation(s)
- Mehmet Emre Atabek
- Department of Pediatrics, Section of Pediatric Endocrinology, School of Medicine, Selcuk University, Konya, Turkey.
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Abstract
Metabolic bone disease in children includes many hereditary and acquired conditions of diverse etiology that lead to disturbed metabolism of the bone tissue. Some of these processes primarily affect bone; others are secondary to nutritional deficiencies, a variety of chronic disorders, and/or treatment with some drugs. Some of these disorders are rare, but some present public health concerns (for instance, rickets) that have been well known for many years but still persist. The most important clinical consequences of bone metabolic diseases in the pediatric population include reduced linear growth, bone deformations, and non-traumatic fractures leading to bone pain, deterioration of motor development and disability. In this article, we analyze primary and secondary osteoporosis, rickets, osteomalacia (nutritional and hereditary vitamin D-dependent, hypophosphatemic and that due to renal tubular abnormalities), renal osteodystrophy, sclerosing bony disorders, and some genetic bone diseases (hypophosphatasia, fibrous dysplasia, skeletal dysplasia, juvenile Paget disease, familial expansile osteolysis, and osteoporosis pseudoglioma syndrome). Early identification and treatment of potential risk factors is essential for skeletal health in adulthood. In most conditions it is necessary to ensure an appropriate diet, with calcium and vitamin D, and an adequate amount of physical activity as a means of prevention. In secondary bone diseases, treatment of the primary disorder is crucial. Most genetic disorders await prospective gene therapies, while bone marrow transplantation has been attempted in other disorders. At present, affected patients are treated symptomatically, frequently by interdisciplinary teams. The role of exercise and pharmacologic therapy with calcium, vitamin D, phosphate, bisphosphonates, calcitonin, sex hormones, growth hormone, and thiazides is discussed. The perspectives on future therapy with insulin-like growth factor-1, new analogs of vitamin D, strontium, osteoprotegerin, and calcimimetics are presented.
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Mantadakis E, Anagnostatou N, Smyrnaki P, Spanaki AM, Papavasiliou ES, Briassoulis G, Kalmanti M. Life-threatening hypercalcemia complicated by pancreatitis in a child with acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2005; 27:288-92. [PMID: 15891568 DOI: 10.1097/01.mph.0000165131.94544.a6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors describe a 9-year-old girl with precursor-B acute lymphoblastic leukemia (ALL) who presented with dehydration and severe hypercalcemia. She had received oral vitamin D and calcium supplementation for 4 days, the last dose 48 hours prior to admission, and required pediatric intensive care unit (PICU) hospitalization for management of the hypercalcemia and safe initiation of induction chemotherapy. Her clinical course was complicated by pancreatitis, disseminated intravascular coagulation, pleural effusion, and focal seizures. Although the exact mechanism of hypercalcemia was not elucidated, it was likely related to the underlying ALL, without dismissing the prior vitamin D and calcium supplementation as a possible contributing factor. The hypercalcemia resolved with specific antileukemic therapy along with supportive care and administration of calcitonin. Hypercalcemia is an uncommon metabolic abnormality in children with ALL, but it can be life-threatening. Children with ALL should be referred to tertiary-care institutions with PICU and subspecialty support because serious metabolic and other complications can occur before or after the administration of chemotherapy.
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Affiliation(s)
- Elpis Mantadakis
- Department of Pediatric Hematology/Oncology, University Hospital of Heraklion, Heraklion, Crete, Greece
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