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Rodríguez-Gutiérrez R, Zapata-Rivera MA, Rodriguez-Velver KV, Lavalle-Gonzalez FJ, Gonzalez-Gonzalez JG, Villarreal-Perez JZ. Severe Hypercalcaemia - Chronic Tophaceous Gout as the Responsible Cause? EUROPEAN ENDOCRINOLOGY 2015; 11:102-104. [PMID: 29632580 PMCID: PMC5819066 DOI: 10.17925/ee.2015.11.02.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 07/08/2015] [Indexed: 12/03/2022]
Abstract
The association of chronic tophaceous gout with severe hypercalcaemia is exceptional. In this case, a 42-year old man with a long-standing history of gout arrived at the emergency room with altered mental status. Laboratory work up revealed a uric acid of 14.0 mg/dl, corrected calcium of 14.5 mg/dl, phosphorous of 6.3 mg/dl, parathyroid hormone (PTH) was suppressed (<3.0 pg/ml), 25-dihydroxyvitamin D 25.2 ng/ml, parathyroid hormone related-protein (PTHrP) was 45.0 pg/ml and calcitriol 19.6 pg/ml. Biopsy histopathology result showed deposits of monosodium urate crystals surrounded by granulomatous inflammation. The association of chronic tophaceous gout with severe hypercalcaemia is extremely rare and has been usually described to be secondary to 1-25 dihydroxyvitamin D (calcitriol) secretion. In this case, calcitriol levels were normal and this possibility was excluded. On the other hand, PTHrP had never been, until now, described as the responsible cause of hypercalcaemia in gout. In our case, baseline PTHrP and calcium values were elevated and after medical treatment both returned to normal values. PTHrP usually causes hypophosphataemia and in this case the abnormal renal function could have diminished this last effect.
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Affiliation(s)
- René Rodríguez-Gutiérrez
- Endocrinology Division, Department of Internal Medicine, University Hospital 'Dr José E González', Unlversldad Autonoma de Nuevo León, Monterrey, México.,Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, US
| | - Maria Azucena Zapata-Rivera
- Endocrinology Division, Department of Internal Medicine, University Hospital 'Dr José E González', Unlversldad Autonoma de Nuevo León, Monterrey, México
| | - Karla Victoria Rodriguez-Velver
- Endocrinology Division, Department of Internal Medicine, University Hospital 'Dr José E González', Unlversldad Autonoma de Nuevo León, Monterrey, México
| | - Fernando J Lavalle-Gonzalez
- Endocrinology Division, Department of Internal Medicine, University Hospital 'Dr José E González', Unlversldad Autonoma de Nuevo León, Monterrey, México
| | - José Gerardo Gonzalez-Gonzalez
- Endocrinology Division, Department of Internal Medicine, University Hospital 'Dr José E González', Unlversldad Autonoma de Nuevo León, Monterrey, México
| | - Jesus Zacarias Villarreal-Perez
- Endocrinology Division, Department of Internal Medicine, University Hospital 'Dr José E González', Unlversldad Autonoma de Nuevo León, Monterrey, México
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de Beus E, Boer WH. Denosumab for treatment of immobilization-related hypercalcaemia in a patient with advanced renal failure. Clin Kidney J 2012; 5:566-71. [PMID: 26069803 PMCID: PMC4400549 DOI: 10.1093/ckj/sfs116] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 07/24/2012] [Indexed: 11/14/2022] Open
Abstract
We describe the case of a young adult with immobilization-related hypercalcaemia and advanced renal insufficiency. Because of the uncertain safety profile of bisphosphonates in such patients, only a low dose of pamidronate was administered twice. This did not result in a sufficient decrease in the serum calcium concentration nor was the decrease sustained. We decided to administer a single dose of denosumab, a monoclonal antibody against the receptor activator of nuclear factor-κB ligand, a new antiresorptive agent registered for use in osteoporosis. This resulted in rapid and sustained decrease in the serum calcium concentration. Transient hypocalcaemia ensued with normalization after vitamin D supplementation. Furthermore, we summarize what is known about hypercalcaemia caused by immobilization.
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Affiliation(s)
- Esther de Beus
- Department of Nephrology and Hypertension , University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Walther H Boer
- Department of Nephrology and Hypertension , University Medical Centre Utrecht , Utrecht , The Netherlands
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Current World Literature. Curr Opin Rheumatol 2011; 23:219-26. [DOI: 10.1097/bor.0b013e3283448536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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