1
|
Agarwal K, Gupta N, Malhotra H. Hypercalcemia in Chronic Myeloid Leukemia: An Unusual Presentation. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1759506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
AbstractHypercalcemia in CML is an unusual paraneoplastic syndrome and is associated with worse prognosis and reduced survival. It usually seen in blast crisis or accelerated phase but can also indicate bony infiltration by cancer cells. Multiple mechanisms can be involved in a patient. We present a case of hypercalcemia in CML in chronic phase without bony infiltration or increased parathormone levels. Increased calcium levels may also be first indication of tyrosine kinase inhibitor resistance. Patient was managed symptomatically with subsequent change of the drug for managing CML. He is currently stable at six months follow-up. Therefore, careful evaluation of the cause of hypercalcemia is necessary for appropriate management.
Collapse
Affiliation(s)
- Khushboo Agarwal
- Department of Oncolgy, Mahatma Gandhi Medical College, Jaipur, Rajasthan, India
| | - Naveen Gupta
- Department of Oncolgy, Mahatma Gandhi Medical College, Jaipur, Rajasthan, India
| | - Hemant Malhotra
- Department of Oncolgy, Mahatma Gandhi Medical College, Jaipur, Rajasthan, India
| |
Collapse
|
2
|
Almuradova E, Cicin I. Cancer-related hypercalcemia and potential treatments. Front Endocrinol (Lausanne) 2023; 14:1039490. [PMID: 37033238 PMCID: PMC10073684 DOI: 10.3389/fendo.2023.1039490] [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: 09/08/2022] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Cancer-related hypercalcemia is a common finding typically seen in patients with advanced cancer and occurs in about 20 to 30 percent of cases. The most common cause of hypercalcemia in hospitalized patients is hypercalcemia due to malignancy.This clinical problem is seen in patients with both solid tumors and patients with hematologic malignancies. Hypercalcemia is associated with a poor prognosis in oncology patients. This pathologic condition can occur due to many different mechanisms but is usually caused by abnormal calcium use resulting from bone resorption, intestinal absorption, or renal excretion. Hypercalcemia may present with a wide range of symptoms ranging from gastrointestinal system symptoms to neurologic symptoms. Timely diagnosis and initiation of treatment by the physician significantly reduce the risk of complications. Treatment aims to decrease serum calcium by increasing calciuresis, decreasing bone resorption, and decreasing intestinal calcium absorption. The mainstays of treatment are IV hydration, bisphosphonates and calcitonin, denosumab, and in some patients, prednisone, and cinacalcet. Patients with underlying advanced kidney disease and refractory severe hypercalcemia should be evaluated for hemodialysis. Every physician dealing with oncology patients should know the fastest and most effective management of hypercalcemia. We aimed to contribute in this sense.
Collapse
Affiliation(s)
| | - Irfan Cicin
- Medical Oncology Department, Faculty of Medicine, Trakya University, Trakya, Türkiye
- *Correspondence: Irfan Cicin,
| |
Collapse
|
3
|
Trikannad Ashwini Kumar AK, Vellanki S, Krishnamoorthy G. Hypercalcemia As the Sole Initial Presentation of Precursor B-cell Acute Lymphoblastic Leukemia. Cureus 2022; 14:e22081. [PMID: 35295359 PMCID: PMC8917470 DOI: 10.7759/cureus.22081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 11/15/2022] Open
Abstract
A 24-year-old female presented with nausea, vomiting and abdominal pain. Physical examination was unremarkable. The patient's laboratory studies showed calcium of 17.2 mg/d, white cell count: 9,000/mcL with a normal peripheral blood smear. The patient had low PTH and PTHrp. She was hydrated, given calcitonin of four units/kg every 12 hours subcutaneously for 24 hours and zoledronate IV 4mg given once, with which calcium levels normalized and symptoms resolved. The patient returned one week later, with bone pain and bruises. Platelet count: 51,000/mcL, WBC count: 9,000/mcL, with lymphocytosis. A peripheral smear showed lymphoblasts. Flow cytometry confirmed precursor B-cell acute lymphoblastic leukemia (ALL) with 43% blasts. Hypercalcemic patients may have blasts at presentation, but can be “aleukemic.” Unexplained hypercalcemia with bone pain should lead to the suspicion of ALL, and a bone marrow exam should be performed even without peripheral blastosis to diagnose and treat ALL immediately.
Collapse
|
4
|
Menè P, Moioli A, Stoppacciaro A, Lai S, Festuccia F. Acute Kidney Injury in Monoclonal Gammopathies. J Clin Med 2021; 10:jcm10173871. [PMID: 34501317 PMCID: PMC8432219 DOI: 10.3390/jcm10173871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 01/07/2023] Open
Abstract
Monoclonal gammopathies (MG) encompass a variety of disorders related to clonal expansion and/or malignant transformation of B lymphocytes. Deposition of free immunoglobulin (Ig) components (light or heavy chains, LC/HC) within the kidney during MG may result over time in multiple types and degrees of injury, including acute kidney injury (AKI). AKI is generally a consequence of tubular obstruction by luminal aggregates of LC, a pattern known as “cast nephropathy”. Monoclonal Ig LC can also be found as intracellular crystals in glomerular podocytes or proximal tubular cells. Proliferative glomerulonephritis with monoclonal Ig deposits is another, less frequent form of kidney injury with a sizable impact on renal function. Hypercalcemia (in turn related to bone reabsorption triggered by proliferating plasmacytoid B cells) may lead to AKI via functional mechanisms. Pharmacologic treatment of MG may also result in additional renal injury due to local toxicity or the tumor lysis syndrome. The present review focuses on AKI complicating MG, evaluating predictors, risk factors, mechanisms of damage, prognosis, and options for treatment.
Collapse
Affiliation(s)
- Paolo Menè
- Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, 00189 Rome, Italy
- Division of Nephrology, Sant’Andrea University Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy; (A.M.); (F.F.)
- Correspondence: ; Tel.: +39-(06)-3377-5949
| | - Alessandra Moioli
- Division of Nephrology, Sant’Andrea University Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy; (A.M.); (F.F.)
| | - Antonella Stoppacciaro
- Division of Pathology, Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, 00189 Rome, Italy;
| | - Silvia Lai
- Division of Nephrology, Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy;
| | - Francescaromana Festuccia
- Division of Nephrology, Sant’Andrea University Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy; (A.M.); (F.F.)
| |
Collapse
|
5
|
Izzedine H, Chazal T, Wanchoo R, Jhaveri KD. Immune checkpoint inhibitor-associated hypercalcaemia. Nephrol Dial Transplant 2020; 37:1598-1608. [PMID: 33374000 DOI: 10.1093/ndt/gfaa326] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Indexed: 01/10/2023] Open
Abstract
Immune checkpoint inhibitors (CPIs) have recently become a cornerstone for the treatment of different advanced cancers. These drugs have the ability to reactivate the immune system against tumour cells but can also trigger a myriad of side effects, termed immune-related adverse events (irAEs). Although there are numerous reports of CPI-related endocrinopathies, hypercalcaemia as a suspected irAE is not well documented. The mechanisms of CPI hypercalcaemia are not clearly established. However, in our review, four distinct causes emerged: endocrine disease-related, sarcoid-like granuloma, humoral hypercalcaemia due to parathyroid-related hormone and hyperprogressive disease following CPI initiation. Prompt recognition of hypercalcaemia and the institution of therapy can be lifesaving, affording the opportunity to address the underlying aetiology. In this review we discuss the incidence, diagnosis and management of immune-related hypercalcaemia in oncological patients receiving CPI agents.
Collapse
Affiliation(s)
- Hassan Izzedine
- Department of Nephrology, Peupliers Private Hospital, Ramsay Générale de Santé, Paris, France
| | - Thibaud Chazal
- Department of Internal Medicine, Pitie-Salpetriere Hospital, Paris, France
| | - Rimda Wanchoo
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, NY, USA
| | - Kenar D Jhaveri
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, NY, USA
| |
Collapse
|
6
|
Prolonged Myelosuppression due to Progressive Bone Marrow Fibrosis in a Patient with Acute Promyelocytic Leukemia. Case Rep Hematol 2019; 2019:1616237. [PMID: 31885950 PMCID: PMC6900957 DOI: 10.1155/2019/1616237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 10/31/2019] [Indexed: 12/22/2022] Open
Abstract
A 34-year-old woman was diagnosed with acute promyelocytic leukemia. Chemotherapy was administered following the JALSG APL204 protocol. Induction therapy with all-trans retinoic acid resulted in complete remission on day 49. She developed coccygeal pain from day 18, which spread to the spine and cheekbones and lasted 5 weeks. She had similar bone pain on days 7–10 of the first consolidation therapy and on days 4–12 of the second consolidation therapy. Oral loxoprofen was prescribed for pain relief. On day 33 of the third consolidation, white blood cell and neutrophil counts were 320/μL and 20/μL, respectively. After she developed epigastralgia and hematemesis, she developed septic shock. Gastroendoscopy revealed markedly thickened folds and diffusely damaged mucosa with blood oozing. Computed tomography revealed thickened walls of the antrum and the pylorus. Despite emergency treatments, she died. Bacterial culture of the gastric fluid yielded Enterobacter cloacae and enterococci growth. Collectively, she was diagnosed with phlegmonous gastritis. Retrospective examination of serial bone marrow biopsy specimens demonstrated progressive bone marrow fibrosis, which may have caused prolonged myelosuppression. Thus, evaluation of bone marrow fibrosis by bone marrow biopsy after each treatment cycle might serve as a predictor of persistent myelosuppression induced by chemotherapy.
Collapse
|
7
|
Tastanova A, Folcher M, Müller M, Camenisch G, Ponti A, Horn T, Tikhomirova MS, Fussenegger M. Synthetic biology-based cellular biomedical tattoo for detection of hypercalcemia associated with cancer. Sci Transl Med 2019; 10:10/437/eaap8562. [PMID: 29669854 DOI: 10.1126/scitranslmed.aap8562] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 03/29/2018] [Indexed: 12/12/2022]
Abstract
Diagnosis marks the beginning of any successful therapy. Because many medical conditions progress asymptomatically over extended periods of time, their timely diagnosis remains difficult, and this adversely affects patient prognosis. Focusing on hypercalcemia associated with cancer, we aimed to develop a synthetic biology-inspired biomedical tattoo using engineered cells that would (i) monitor long-term blood calcium concentration, (ii) detect onset of mild hypercalcemia, and (iii) respond via subcutaneous accumulation of the black pigment melanin to form a visible tattoo. For this purpose, we designed cells containing an ectopically expressed calcium-sensing receptor rewired to a synthetic signaling cascade that activates expression of transgenic tyrosinase, which produces melanin in response to persistently increased blood Ca2+ We confirmed that the melanin-generated color change produced by this biomedical tattoo could be detected with the naked eye and optically quantified. The system was validated in wild-type mice bearing subcutaneously implanted encapsulated engineered cells. All animals inoculated with hypercalcemic breast and colon adenocarcinoma cells developed tattoos, whereas no tattoos were seen in animals inoculated with normocalcemic tumor cells. All tumor-bearing animals remained asymptomatic throughout the 38-day experimental period. Although hypercalcemia is also associated with other pathologies, our findings demonstrate that it is possible to detect hypercalcemia associated with cancer in murine models using this cell-based diagnostic strategy.
Collapse
Affiliation(s)
- Aizhan Tastanova
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, CH-4058 Basel, Switzerland
| | - Marc Folcher
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, CH-4058 Basel, Switzerland
| | - Marius Müller
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, CH-4058 Basel, Switzerland
| | - Gieri Camenisch
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, CH-4058 Basel, Switzerland
| | - Aaron Ponti
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, CH-4058 Basel, Switzerland
| | - Thomas Horn
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, CH-4058 Basel, Switzerland
| | - Maria S Tikhomirova
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, CH-4058 Basel, Switzerland
| | - Martin Fussenegger
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, CH-4058 Basel, Switzerland. .,Faculty of Science, University of Basel, Mattenstrasse 26, CH-4058 Basel, Switzerland
| |
Collapse
|
8
|
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
Collapse
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
| |
Collapse
|
9
|
Rujirachun P, Junyavoraluk A, Owattanapanich W, Suvannarerg V, Sirinvaravong S. Leukemic arthritis and severe hypercalcemia in a man with chronic myeloid leukemia: a case report and review of the literature. J Med Case Rep 2018; 12:257. [PMID: 30196795 PMCID: PMC6130082 DOI: 10.1186/s13256-018-1798-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/09/2018] [Indexed: 12/29/2022] Open
Abstract
Background Patients with chronic myeloid leukemia typically present with high white blood cell counts revealed during annual checkups. Leukemic arthritis and hypercalcemia are rare manifestations in patients with chronic myeloid leukemia. Case presentation A 35-year-old Thai man who had been diagnosed with chronic myeloid leukemia in the chronic phase developed blast crisis while he was receiving ongoing treatment with imatinib at 400 mg/day. Initially, he presented with oligoarthritis in both knees and ankles. A bone scintigraphy showed a prominent bony uptake, with a symmetrical, increased uptake in many bone areas. Induction therapy with a 7 + 3 induction regimen was prescribed in conjunction with 600 mg of imatinib once daily before switching to 140 mg of dasatinib. He subsequently developed severe hypercalcemia (total serum calcium of 17.8 mg/dL), with generalized osteolytic lesions detected on a bone survey. His serum vitamin D level was 50.64 ng/mL, while the serum parathyroid hormone level was 9.82 pg/mL. Despite the administration of an aggressive intravenously administered hydration, intravenously administered calcitonin, and 600 mg/day of imatinib, the severe hypercalcemia was refractory. We therefore decided to prescribe 20 mg/day of intravenously administered dexamethasone; fortunately, his serum calcium level decreased dramatically to normal range within a few days. Conclusions Although leukemic arthritis and severe hypercalcemia are extraordinary presentations in patients with chronic myeloid leukemia, the advanced phase of the disease might bring on these symptoms. Apart from parathyroid hormone-related protein-related hypercalcemia, vitamin D is a mechanism of humoral-mediated hypercalcemia. Electronic supplementary material The online version of this article (10.1186/s13256-018-1798-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | | | - Weerapat Owattanapanich
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
| | - Voraparee Suvannarerg
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirinart Sirinvaravong
- Division of Endocrine and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
10
|
Auron A, Alon US. Hypercalcemia: a consultant's approach. Pediatr Nephrol 2018; 33:1475-1488. [PMID: 28879535 DOI: 10.1007/s00467-017-3788-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/24/2017] [Accepted: 08/11/2017] [Indexed: 12/11/2022]
Abstract
Due to their daily involvement in mineral metabolism, nephrologists are often asked to consult on children with hypercalcemia. This might become even more pertinent when the hypercalcemia is associated with acute kidney injury and/or hypercalciuria and renal calcifications. The best way to assess the severity of hypercalcemia is by measurement of plasma ionized calcium, and if not available by adjusting serum total calcium to albumin concentration. The differential diagnosis of the possible etiologies of the disturbance in the mineral homeostasis starts with the assessment of serum parathyroid hormone concentration, followed by that of vitamin D metabolites in search of both genetic and acquired etiologies. Several tools are available to acutely treat hypercalcemia with the current main components being fluids, loop diuretics, and antiresorptive agents. This review will address the pathophysiologic mechanisms, clinical manifestations, and treatment modalities involved in hypercalcemia.
Collapse
Affiliation(s)
- Ari Auron
- Bone and Mineral Disorders Clinic, Division of Pediatric Nephrology, Children's Mercy Hospital, University of Missouri at Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Uri S Alon
- Bone and Mineral Disorders Clinic, Division of Pediatric Nephrology, Children's Mercy Hospital, University of Missouri at Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA.
| |
Collapse
|
11
|
Catalano A, Chilà D, Bellone F, Nicocia G, Martino G, Loddo I, Morabito N, Benvenga S, Loddo S. Incidence of hypocalcemia and hypercalcemia in hospitalized patients: Is it changing? JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2018; 13:9-13. [PMID: 30023309 PMCID: PMC6047106 DOI: 10.1016/j.jcte.2018.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/15/2018] [Accepted: 05/27/2018] [Indexed: 12/04/2022]
Abstract
Disorders of calcium metabolism are frequently encountered in clinical practice. Hypocalcemia accounted for 27.72% and hypercalcemia for 4.74% of inpatients. Incidence of hypo- and hypercalcemia changed over time.
Disorders of calcium metabolism are frequently encountered in routine clinical practice. However limited data are available on the epidemiology of hypocalcemia and hypercalcemia in hospitalized patients. Our aim was to evaluate the frequency of hypocalcemia and hypercalcemia in hospitalized patients. This is a retrospective study based on the laboratory results of all hospitalized subjects (n = 12,334) whose calcemia was determined between January 1st, 2011 and December 31st, 2014. Measurements of serum calcium were carried out by a single centralized laboratory. Hypocalcemia was defined as serum calcium levels <8.2 mg/dl and hypercalcemia as serum calcium levels >10.4 mg/dl. Albumin correction was applied to adjust serum calcium values. Overall, hypocalcemia accounted for 27.72% (n = 3420) and hypercalcemia for 4.74% (n = 585) of the 12,334 inpatients. The highest prevalence of hypocalcemia was found in patients over 65 yr. (n = 2097, 61.31%) vs. younger subjects, while the highest prevalence of hypercalcemia was observed in patients aged 0–18 yr. (n = 380, 64.95%). Hypocalcemia was more often encountered in males (n = 1952, 57.07%) while no gender differences were found regarding hypercalcemia. Incidence of hypocalcemia changed over time varying from 35.42% (n = 1061) in 2011 to 21.93% (n = 672) in 2014 (r = −0.98; p = 0.01). Differently, incidence of hypercalcemia did not significantly increase significantly from 3.47% (n = 104) in 2011 to 6.92% (n = 211) in 2014 (r = 0.94; p = 0.052). Despite increased awareness about electrolytes disturbance, physicians should consider calcium levels because of life-threatening consequences associated to hypo- and hypercalcemia. Patient’s gender and age could be associated to a different risk of calcium disturbance in hospitalized patients.
Collapse
Affiliation(s)
- A Catalano
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - D Chilà
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - F Bellone
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - G Nicocia
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - G Martino
- Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, Messina, Italy
| | - I Loddo
- Department of Laboratory Medicine and Advanced Biotechnologies, Mediterranean Institute for Transplantation and Advanced Specialized Therapies - ISMETT - IRCCS, Palermo, Italy
| | - N Morabito
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - S Benvenga
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy.,Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, Italy.,Interdepartmental Program of Molecular & Clinical Endocrinology and Women's Endocrine Health, University Hospital Policlinico G. Martino, Messina, Italy
| | - S Loddo
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| |
Collapse
|
12
|
Ibrahim T, Farolfi A, Mercatali L, Ricci M, Amadori D. Metastatic Bone Disease in the Era of Bone-Targeted Therapy: Clinical Impact. TUMORI JOURNAL 2018; 99:1-9. [DOI: 10.1177/030089161309900101] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Advances in the diagnosis and treatment of tumors by surgery, chemotherapy, biotherapy, radiotherapy and other modalities have increased the survival of cancer patients over the last 20 years. As a consequence, bone now represents the third most common site of metastatic involvement after the lung and liver. Approximately 20–25% of patients with neoplastic disease develop clinically evident bone metastases (BMs) during the natural course of their illness, with a further 50% of such lesions being identified during autopsy. BMs are the major cause of morbidity in cancer patients because of their epidemiological and clinical impact. Pain is the most frequent symptom in about 75% of patients but other serious complications can also occur, such as pathological fractures, spinal cord compression, hypercalcemia and bone marrow suppression. These complications worsen the patient's general condition and reduce patients’ mobility, facilitating the development of lung infections, skin ulcers, deep vein thrombosis, etc., and ultimately reducing prognosis and quality of life. The frequency of serious complications depends on the site and type of lesions and the treatment administered. Over the last 10 years, the introduction of bisphosphonates for the treatment of patients with BMs has led to a marked decrease in the frequency of complications, thus improving quality of life and clinical outcome. Furthermore, progress in understanding the pathophysiology of bone metastases has resulted in the development of new bone-targeted molecules such as denosumab. We therefore felt it would be useful to report on the epidemiological, clinical and economic impact of bone disease in a cancer setting.
Collapse
Affiliation(s)
- Toni Ibrahim
- Osteoncology and Rare Tumors Center, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | - Alberto Farolfi
- Osteoncology and Rare Tumors Center, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | - Laura Mercatali
- Osteoncology and Rare Tumors Center, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | - Marianna Ricci
- Osteoncology and Rare Tumors Center, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | - Dino Amadori
- Osteoncology and Rare Tumors Center, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| |
Collapse
|
13
|
Toro-Tobón D, Agosto S, Ahmadi S, Koops M, Bruder JM. Chronic Myeloid Leukemia Associated Hypercalcemia: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:203-207. [PMID: 28239141 PMCID: PMC5340222 DOI: 10.12659/ajcr.902467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Patient: Male, 58 Final Diagnosis: Hypercalcemia Symptoms: Confusion • dehydration Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolism
Collapse
Affiliation(s)
| | - Sarimar Agosto
- Division of Endocrinology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Sara Ahmadi
- Division of Endocrinology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Maureen Koops
- Division of Endocrinology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Department of Endocrinology, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Jan M Bruder
- Division of Endocrinology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Goldner W. Reply to C. Taylor. J Oncol Pract 2016; 12:1277. [PMID: 27875072 DOI: 10.1200/jop.2016.017335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
17
|
|
18
|
Abstract
Hypercalcemia occurs in up to 4% of the population in association with malignancy, primary hyperparathyroidism, ingestion of excessive calcium and/or vitamin D, ectopic production of 1,25-dihydroxyvitamin D [1,25(OH)2D], and impaired degradation of 1,25(OH)2D. The ingestion of excessive amounts of vitamin D3 (or vitamin D2) results in hypercalcemia and hypercalciuria due to the formation of supraphysiological amounts of 25-hydroxyvitamin D [25(OH)D] that bind to the vitamin D receptor, albeit with lower affinity than the active form of the vitamin, 1,25(OH)2D, and the formation of 5,6-trans 25(OH)D, which binds to the vitamin D receptor more tightly than 25(OH)D. In patients with granulomatous disease such as sarcoidosis or tuberculosis and tumors such as lymphomas, hypercalcemia occurs as a result of the activity of ectopic 25(OH)D-1-hydroxylase (CYP27B1) expressed in macrophages or tumor cells and the formation of excessive amounts of 1,25(OH)2D. Recent work has identified a novel cause of non-PTH-mediated hypercalcemia that occurs when the degradation of 1,25(OH)2D is impaired as a result of mutations of the 1,25(OH)2D-24-hydroxylase cytochrome P450 (CYP24A1). Patients with biallelic and, in some instances, monoallelic mutations of the CYP24A1 gene have elevated serum calcium concentrations associated with elevated serum 1,25(OH)2D, suppressed PTH concentrations, hypercalciuria, nephrocalcinosis, nephrolithiasis, and on occasion, reduced bone density. Of interest, first-time calcium renal stone formers have elevated 1,25(OH)2D and evidence of impaired 24-hydroxylase-mediated 1,25(OH)2D degradation. We will describe the biochemical processes associated with the synthesis and degradation of various vitamin D metabolites, the clinical features of the vitamin D-mediated hypercalcemia, their biochemical diagnosis, and treatment.
Collapse
Affiliation(s)
- Peter J Tebben
- Divisions of Endocrinology (P.J.T., R.K.) and Nephrology and Hypertension (R.K.), and Departments of Pediatric and Adolescent Medicine (P.J.T.), Internal Medicine (P.J.T., R.K.), Laboratory Medicine and Pathology (R.J.S.), and Biochemistry in Molecular Biology (R.K.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905
| | - Ravinder J Singh
- Divisions of Endocrinology (P.J.T., R.K.) and Nephrology and Hypertension (R.K.), and Departments of Pediatric and Adolescent Medicine (P.J.T.), Internal Medicine (P.J.T., R.K.), Laboratory Medicine and Pathology (R.J.S.), and Biochemistry in Molecular Biology (R.K.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905
| | - Rajiv Kumar
- Divisions of Endocrinology (P.J.T., R.K.) and Nephrology and Hypertension (R.K.), and Departments of Pediatric and Adolescent Medicine (P.J.T.), Internal Medicine (P.J.T., R.K.), Laboratory Medicine and Pathology (R.J.S.), and Biochemistry in Molecular Biology (R.K.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905
| |
Collapse
|
19
|
Canet E, Vincent F, Darmon M, Soares M. Acute kidney injury in hematological patients. Curr Opin Crit Care 2016; 21:549-58. [PMID: 26539929 DOI: 10.1097/mcc.0000000000000253] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The present article reviews the recent literature on the main aspects of acute kidney injury (AKI) developing in patients with hematological malignancies admitted to ICU. RECENT FINDINGS Up to two thirds of critically ill patients with hematological malignancies develop AKI. Current mortality rates range from 40 to 60% for most patients with hematological malignancies, except for recipients of allogeneic hematopoietic stem cell transplantation in whom outcomes remain very poor. Renal function recovery occurs in most patients with AKI, but is dependent on the underlying causes. AKI is usually multifactorial, resulting from causes common to other ICU patients and related to the underlying malignancy or its treatment. New targeted therapies and treatment strategies are potentially associated with AKI. Management of these patients requires a high degree of suspicion, close monitoring of metabolic parameters, and use of preventive strategies to limit risk of AKI or to mitigate its severity. SUMMARY AKI is a frequent and severe complication in critically ill patients with hematological malignancies. As the clinical management is complex, close collaboration with hematologists is paramount.
Collapse
Affiliation(s)
- Emmanuel Canet
- aMedical Intensive Care Unit, Saint-Louis University Hospital, Paris bMedical-Surgical Intensive Care Unit, Intercommunal Hospital Le Raincy-Montfermeil, Montfermeil cMedical-Surgical Intensive Care Unit, Saint-Etienne University Hospital, Saint-Priest-En-Jarez and Jean Monnet Medical School, Saint-Etienne, France dDepartment of Critical Care, D'Or Institute for Research and Education ePost-Graduation Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | | | | | | |
Collapse
|
20
|
Martins AL, Moniz M, Nunes PS, Abadesso C, Loureiro HC, Almeida HI, Duarte X. Reply to: Severe hypercalcemia as a form of acute lymphoblastic leukemia presentation in children. Rev Bras Ter Intensiva 2016; 28:201-2. [PMID: 27410416 PMCID: PMC4943060 DOI: 10.5935/0103-507x.20160035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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
| | - Helena Isabel Almeida
- 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, Francisco Gentil, Lisboa, Portugal
| |
Collapse
|
21
|
Kunstel KL. Oncologic Emergencies. PHYSICIAN ASSISTANT CLINICS 2016. [DOI: 10.1016/j.cpha.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Gonsalves WI, Godby K, Kumar SK, Costa LJ. Limiting early mortality: Do's and don'ts in the management of patients with newly diagnosed multiple myeloma. Am J Hematol 2016. [PMID: 26214377 DOI: 10.1002/ajh.24129] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In the era of novel biological agents, multiple myeloma (MM) is often approached as a chronic condition. While survival continues to improve, population-level data indicate that early mortality remains a substantial barrier to advances in MM outcomes. Here we provide "do's and don'ts" management recommendations that may minimize the risk of early mortality and ensure that patients have the opportunity to benefit from the long term impact of new effective MM agents. Such recommendations encompass the early introduction of novel agents even in the presence of comorbidities and advanced age and aggressive management of MM-related complications.
Collapse
Affiliation(s)
| | - Kelly Godby
- Division of Hematology and Oncology; University of Alabama at Birmingham; Birmingham Alabama
| | - Shaji K. Kumar
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Luciano J. Costa
- Division of Hematology and Oncology; University of Alabama at Birmingham; Birmingham Alabama
| |
Collapse
|
24
|
Lupica R, Buemi M, Campennì A, Trimboli D, Canale V, Cernaro V, Santoro D. Unexpected hypercalcemia in a diabetic patient with kidney disease. World J Nephrol 2015; 4:438-443. [PMID: 26167468 PMCID: PMC4491935 DOI: 10.5527/wjn.v4.i3.438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/14/2015] [Accepted: 04/30/2015] [Indexed: 02/06/2023] Open
Abstract
We report a case of a diabetic patient with progressive chronic kidney disease and unexplained hypercalcemia. This unusual presentation and the investigation of all possible causes led us to perform a renal biopsy. The systemic sarcoidosis diagnosis was confirmed by the presence of interstitial multiple granulomas composed of epithelioid and multinucleated giant cells delimited by a thin fibrous reaction, and by pulmonary computed tomography finding of numerous lumps with ground-glass appearance. Sarcoidosis most commonly involves lungs, lymph nodes, skin and eyes, whilst kidney is less frequently involved. When it affects males it is characterized by hypercalcemia, hypercalciuria, and progressive loss of renal function. Early treatment with steroids allows for a gradual improvement in renal function and normalization of calcium serum values. Otherwise, the patient would quickly progress to end stage renal disease. Finding of hypercalcemia in a patient with renal failure must alert physicians because it may be a sign of several pathological entities.
Collapse
|
25
|
[Life-threatening hypercalcemia as the initial presentation of childhood acute lymphoblastic leukemia]. Arch Pediatr 2015; 22:608-12. [PMID: 25896627 DOI: 10.1016/j.arcped.2015.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 10/08/2014] [Accepted: 03/05/2015] [Indexed: 11/21/2022]
Abstract
Hypercalcemia in childhood acute lymphoblastic leukaemia (ALL) is a well-known but uncommon complication. Here, we report a case of B-ALL in which the first signs were life-threatening hypercalcemia associated with diffuse osteolytic lesions with no hematologic abnormalities. We draw attention to the difficulties formally establishing the ALL diagnosis. Bone marrow examinations must be repeated if necessary. Furthermore, biological, cytogenetic, and molecular aspects need to be investigated. Measurement of intact PTH can exclude hyperparathyroidism. PTHrP is possibly involved in hypercalcemia processes induced by tumor cells. The t(17;19) translocation and its E2A-HLF transcript fusion, which have been thought to be a poor prognostic factor, must be determined. Regarding severe hypercalcemia control, treatment is based on both underlying disease management and serum calcium level reduction with aggressive hydration and if necessary bisphosphonates.
Collapse
|
26
|
Ding L, Xiao X, Huang L. Peripheral T-cell lymphoma with hypercalcemic crisis as a primary symptom accompanied by polymyositis: A case report and review of the literature. Oncol Lett 2014; 9:231-234. [PMID: 25435965 PMCID: PMC4246622 DOI: 10.3892/ol.2014.2661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 10/15/2014] [Indexed: 11/24/2022] Open
Abstract
The present study reports the case of a 61-year-old male with polymyositis who presented with exacerbated weakness in the lower limbs and a recurrent fever that had persisted for one month. Positron emission tomography/computed tomography scans revealed multiple regions of elevated fluorodeoxyglucose metabolism in the lymph nodes, lungs, liver, spleen and bones. While symptoms of nonchalance and confusion were identified on admission, the patient’s serum calcium level was high at 3.87 mmol/l, so a hypercalcemic crisis was confirmed. A biopsy of the right lingual lymph node revealed peripheral T-cell lymphoma, not otherwise specified. The serum calcium level was restored to within the normal range following emergency measures, such as saline rehydration, diuretics, calcitonin and glucocorticoids, and partial remission was achieved following two courses of chemotherapy. The study may improve our present understanding of the diagnosis and treatment of cancer-associated myositis (CAM) and malignancy-associated hypercalcemia.
Collapse
Affiliation(s)
- Luyin Ding
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University Medical College, Hangzhou, Zhejiang 310009, P.R. China
| | - Xibin Xiao
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University Medical College, Hangzhou, Zhejiang 310009, P.R. China
| | - Liansheng Huang
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University Medical College, Hangzhou, Zhejiang 310009, P.R. China
| |
Collapse
|
27
|
Wu CY, Huang CJ, Chiu YW, Huang CT, Chuang HY. A retrospective analysis of the factors associated with hypercalcaemia in patients with advanced cancer. Eur J Cancer Care (Engl) 2013; 23:695-700. [PMID: 24304462 DOI: 10.1111/ecc.12161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2013] [Indexed: 11/27/2022]
Abstract
Hypercalcaemia, a common complication of advanced cancer, causes multiple clinical symptoms, deteriorates patients' quality of life, and is associated with poor prognoses. This study aimed to identify the factors that may be associated with hypercalcaemia in advanced cancer by retrospectively reviewing the medical records of patients (n = 404) admitted to the palliative ward of the Kaohsiung Medical University Hospital, Taiwan, from 2006 to 2008. Patients' demographics, clinical data and symptoms were recorded. Seventy-nine of 404 patients had hypercalcaemia (19.6%), predominant in cases of head-and-neck cancer and haematological malignancies (P < 0.05), but not in those of bone metastases. Hypercalcaemia was associated with consciousness disturbances and leucocytosis (P < 0.05). We recommend that ionised (corrected) calcium levels be monitored clinically in patients with advanced cancer especially when consciousness disturbances are noted, or when head-and-neck or haematological malignancies are present. Testing of free calcium levels is also recommended in patients with leucocytosis.
Collapse
Affiliation(s)
- C Y Wu
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | | | | | | |
Collapse
|
28
|
Rosner MH, Dalkin AC. Onco-nephrology: the pathophysiology and treatment of malignancy-associated hypercalcemia. Clin J Am Soc Nephrol 2012; 7:1722-9. [PMID: 22879438 DOI: 10.2215/cjn.02470312] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Hypercalcemia complicates the course of 10%-30% of all patients with malignancies and can be a sign of very poor prognosis and advanced malignancy. Prompt recognition of the nonspecific signs and symptoms of hypercalcemia and institution of therapy can be lifesaving, affording the opportunity to address the underlying etiology. The mechanisms of malignancy-associated hypercalcemia generally fall into three categories: humoral hypercalcemia due to secreted factors (such as parathyroid-related hormone), local osteolysis due to tumor invasion of bone, and absorptive hypercalcemia due to excess vitamin D produced by malignancies. The mainstays of therapy for hypercalcemia are aggressive intravenous volume expansion with saline, bisphosphonate therapy, and perhaps loop diuretics. Adjunctive therapy may include calcitonin and corticosteroids. In refractory cases, gallium nitrate and perhaps denosumab are alternatives. In patients presenting with severe AKI, hemodialysis with a low-calcium bath can be effective. In most cases, therapy normalizes calcium levels and allows for palliation or curative therapy of the malignancy.
Collapse
Affiliation(s)
- Mitchell H Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville, VA 22908, USA.
| | | |
Collapse
|
29
|
Zhang JTW, Chan C, Kwun SY, Benson KA. A case of severe 1,25-dihydroxyvitamin D-mediated hypercalcemia due to a granulomatous disorder. J Clin Endocrinol Metab 2012; 97:2579-83. [PMID: 22639294 DOI: 10.1210/jc.2012-1357] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND Profound hypercalcemia is usually due to underlying malignancy. CASE We describe a case of granulomatous myositis presenting with extreme hypercalcemia of 20.1 mg/dl and generalized weakness that did not resolve despite rapid correction of serum calcium. The disease process was unmasked by cholecalciferol supplementation. Initial search for a malignant process yielded no diagnosis, but an elevated 1,25-dihydroxyvitamin D level, in the setting of a suppressed PTH and undetectable PTHrP, pointed to the presence of excessive 1α-hydroxylase activity. METHODS AND RESULTS Biopsy of the vastus lateralis muscle showed extensive granulomatous myositis. Immunohistochemical staining for 1α-hydroxylase was localized to the multinucleated giant cells and histiocytes. Musculoskeletal magnetic resonance imaging showed involvement of proximal muscle groups of both thighs and upper limbs. CONCLUSION Measurement of vitamin D metabolites is pivotal in diagnosing 1,25-dihydroxyvitamin D-mediated hypercalcemia. Granulomatous disease can occasionally cause profound hypercalcemia and needs to be considered in the differential diagnosis. 1,25-Dihydroxyvitamin D-mediated hypercalcemia is responsive to glucocorticoid therapy.
Collapse
Affiliation(s)
- Jane Tong Wen Zhang
- Department of Endocrinology and Metabolism, Concord Repatriation General Hospital, Concord, New South Wales 2137, Australia.
| | | | | | | |
Collapse
|
30
|
García Salido A, Nieto Moro M, Casado Flores J. Dificultad respiratoria en el niño con cáncer. Med Intensiva 2011; 35:562-8. [DOI: 10.1016/j.medin.2011.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Accepted: 06/09/2011] [Indexed: 11/16/2022]
|
31
|
Intravascular B-cell lymphoma with hypercalcemia as the initial presentation. Int J Hematol 2011; 94:567-70. [PMID: 22045306 DOI: 10.1007/s12185-011-0959-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 10/17/2011] [Accepted: 10/20/2011] [Indexed: 12/14/2022]
Abstract
Intravascular B-cell lymphoma (IVLBCL) is a rare subtype of extranodal diffuse large B-cell lymphoma, which is characterized by the growth of lymphoma cells within blood vessel lumina without nodular lesions, and which predominantly affects elderly patients. IVLBCL is characterized by B-symptoms and a variety of systemic symptoms due to focal obstruction of blood flow, but may be difficult to diagnose due to its peculiar intravascular localization and the lack of nodular lesions. While hypercalcemia is one of the complications of various types of cancerous diseases, it has rarely been reported as the first presentation of IVLBCL. In this report, we present the case of a 71-year-old male with IVLBCL who showed hypercalcemia accompanied by elevation of serum parathyroid hormone-related protein (PTH-rP) as the initial presentation. Interestingly, immunohistochemical staining revealed that the intravascular lymphoma cells expressed high levels of PTHrP. Six courses of immunochemotherapy, consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP), and two courses of high-dose methotrexate induced complete remission (CR) and retained CR for 4 months. We also reviewed other IVBCL cases in which hypercalcemia was the initial presentation. We suggest that IVLBCL, although rare, should be considered as a possible causative in hypercalcemia of unknown underlying disease.
Collapse
|
32
|
Dargart JL, Hijiya N. Metabolic Emergencies in the Child With Acute Leukemia. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2011. [DOI: 10.1016/j.cpem.2011.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
33
|
Lewis MA, Hendrickson AW, Moynihan TJ. Oncologic emergencies: Pathophysiology, presentation, diagnosis, and treatment. CA Cancer J Clin 2011; 61:287-314. [PMID: 21858793 DOI: 10.3322/caac.20124] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Oncologic emergencies can occur at any time during the course of a malignancy, from the presenting symptom to end-stage disease. Although some of these conditions are related to cancer therapy, they are by no means confined to the period of initial diagnosis and active treatment. In the setting of recurrent malignancy, these events can occur years after the surveillance of a cancer patient has been appropriately transferred from a medical oncologist to a primary care provider. As such, awareness of a patient's cancer history and its possible complications forms an important part of any clinician's knowledge base. Prompt identification of and intervention in these emergencies can prolong survival and improve quality of life, even in the setting of terminal illness. This article reviews hypercalcemia, hyponatremia, hypoglycemia, tumor lysis syndrome, cardiac tamponade, superior vena cava syndrome, neutropenic fever, spinal cord compression, increased intracranial pressure, seizures, hyperviscosity syndrome, leukostasis, and airway obstruction in patients with malignancies. Chemotherapeutic emergencies are also addressed.
Collapse
Affiliation(s)
- Mark A Lewis
- Senior Hematology and Oncology Fellow, Division of Hematology, Department of Oncology, Mayo Clinic College of Medicine, Rochester, MN
| | | | | |
Collapse
|