جستجوی مقالات مرتبط با کلیدواژه "hypercalcemia" در نشریات گروه "پزشکی"

 Among the many causes of pancreatitis, primary hyperparathyroidism (PHPT) is rarely associated with pancreatitis. However, the causal relationship between the two is still controversial. Our aim was to investigate and describe the nature of pancreatic disease in PHPT.

In the present systematic review, all qualitative articles related to the objectives of the study, published from 2008 to January 2024, were reviewed. Search in Magiran database, IranDoc, IranMedex, SID, Cochrane library, Google Scholar, ProQuest, Scopus, Web of Science, and PubMed/Medline Embase with keywords: acute pancreatitis, chronic pancreatitis Hypercalcemia, parathyroid  adenoma  Primary  hyperparathyroidism. Acute pancreatitis, chronic pancreatitis, hypercalcemia, primary hyperparathyroidism, and parathyroid adenoma were performed. The entry criteria were articles in English or Farsi, qualitative articles related to the objectives of the study. Exclusion criteria were articles that were in the form of posters, speeches, letters to the editor, and quantitative studies.

The findings from the review of 20 qualitative studies showed that although the relationship between hypercalcemia caused by parathyroid adenoma and acute pancreatitis is a known medical phenomenon, it is very rare. Therefore, the pathophysiology of acute pancreatitis caused by hypercalcemia is not well understood, although some mechanisms have been suggested. Timely diagnosis of hypercalcemia and parathyroid adenoma surgery is the final treatment.

Acute pancreatitis is the first manifestation of a rare clinical symptom caused by hyperkalemia caused by hyperparathyroidism.

 Hypercalcemia, although less prevalent, is a critical diagnosis in pediatric patients, consisting of numerous etiologies that differ significantly from those in adults. In children, congenital causes are more prevalent. The differential diagnosis of hypercalcemia encompasses a broad spectrum of etiologies; however, up to 90% of all cases are diagnosed with either primary hyperparathyroidism or malignancy. Primary hyperparathyroidism predominates in ambulatory patients, while malignancy is more common among critically ill hospitalized patients.

 This review addresses several important issues related to calcium metabolism and hypercalcemia:a) Overview of Calcium Metabolism
b) Factors affecting serum total and ionized calcium concentration
c) Clinical manifestations and importance of Hypercalcemia in pediatric patients
d) Overview of the causes of Hypercalcemia in pediatric patients
e) Overview of Hypercalcemia management

 A literature search was conducted for articles published from 2000 to 2024 using PubMed, Scopus, Web of Science, Cochrane, and Embase databases. The keywords used were: CALCIUM, Calcium metabolism disorders, hypercalcemia, Parathyroid hormone, Vitamin D, and acid-base imbalance.

 This study provides a review of calcium metabolism and factors affecting total and ionized calcium concentrations, along with a definition of hypercalcemia, classification of its severity, its clinical manifestations, and a comprehensive overview of hypercalcemia etiologies categorized into parathyroid hormone (PTH)-related and unrelated causes. An overview of its management is also included.

 Hypercalcemia is an important disorder in both pediatric and adult patients. Before initiating a workup for hypercalcemia, it is crucial to understand the physiology of calcium and the factors affecting its serum concentrations. The etiologies of hypercalcemia in pediatric patients have a wide spectrum of differential diagnoses; primary hyperparathyroidism and malignancies account for 80-90% of all hypercalcemia cases found in clinical practice. Genetic and syndromic causes are usually more prevalent in pediatrics due to the nature of these conditions. Managing hypercalcemia requires two simultaneous approaches: first, measures aimed at lowering serum calcium concentrations and second, a workup for the underlying cause.

The effects of vitamin D on the skeletal system, biological metabolism, and immune system function are well shown. Cholecalciferol (vitamin D2) and ergocalciferol (vitamin) are 2 major types of vitamin D. Vitamin D3 deficiency is worldwide and the intoxication induced by it is very rare.

Vitamin D3 is involved in calcium hemostasis. The effects of acute hypercalcemia on blood pressure were established. Hypercalcemia can elevate the blood pressure, and renal failure may predispose the individual to a hypertensive response. The clinical symptoms often associated with vitamin D3 intoxication are related to acute renal failure. Hypertension without acute renal failure symptoms can emphasize the relationship between acute hypercalcemia and hypertension.

Subcutaneous fat necrosis (SFN) of the newborn is a rare form of panniculitis. It usually occurs in perinatal stress and is usually complicated by metabolic disorders such as hypercalcemia. While the number of cases reported worldwide has increased, there are very few cases from Nigeria.

 We report the case of a Nigerian newborn admitted at 25 hours of life with macrosomia (birth weight of 4.7 kg) and perinatal asphyxia. On the fourth day of life, she developed reddened to dark, tender areas on the back (20 x 15 cm) and back of the arms, suggestive of SFN with elevated serum calcium. The baby received oral frusemide with the resolution of hypercalcemia by the 4th month of life.

Panniculitis, as a form of subcutaneous fat necrosis should be considered in a neonate with a history of perinatal asphyxia and macrosomia, which requires measurement of serum calcium levels.

Hypercalcemia is a rare manifestation in systemic lupus erythematosus (SLE) patients. In this case report, a thirty-five-year-old woman with a 3-year-old history of lupus was reported. Our case had symptoms of SLE flare, including joint pain, hair loss, photosensitivity, high level of calcium and creatinine, and lymphadenopathy. In her brain magnetic resonance imaging, intracranial hemorrhage was detected. Given her high serum level of calcium and phosphorus, reduced parathyroid hormone, and normal level of vitamin D, her hypercalcemia was attributed to the presence of stimulating parathyroid hormone receptor autoantibody. Regarding the findings of this study, it is suggested to consider SLE as a rare but possiblecause of severe hypercalcemia.

Calcium is a necessary mineral for life to keep the body and bones healthy. Various factors including hormones, diet, age, and gender affect serum calcium status. The aim of this sturdy was to assess the serum calcium level (SCL) of Tehran population, which has about 10 million multi-Ethnic populations and represents from the whole country.

In this retrospective study, the measured SCL of 105,128 individuals referred to different laboratories of Tehran, Iran were evaluated and its relationship with the age, gender, seasons, and different years during 2009-2018, were analyzed.

After excluding outliers, 91,257samples remained, which 61162 (58.64%) and 30,095 (41.36%) were female and male, respectively.  The mean SCL was 9.36 (9.35, 9.37) mg/dl (95%CI). The highest and lowest SCLs were 3.1 and 18.2mg/dl, respectively. From the total study population, 74127 (81.23%) had normal SCLs, 14110 (15.46%) had hypocalcemia, and 3020 (3.31%) had hypercalcemia. SCLs were normal in 83.6% of men and 79.66% of women. Women had a significantly higher frequency of hypocalcemia compared to men (17.2% vs. 12.83%, p<0.0001).

Normal and abnormal SCLs were significantly different in age groups and in both genders. It means that gender and age affect SCLs. Every year of increasing age, reduces the chance of hypercalcemia by 40%, significantly. Age seems to affect hypercalcemia more than hypocalcemia. Age in men increases the risk of hypocalcemia, and reduces the risk of hypocalcemia in women. Therefore, it is recommended to encourage dietary calcium intake among premenopausal women and older men.

Inadvertent and erroneous prescription of vitamin D beyond the recommended dosage and route of administration can cause vitamin D intoxication in children. Infants are particularly vulnerable to such toxicity. Clinical features are due to hypercalcemia, ranging from mild to life-threatening symptoms. We report two infants and one child who had varied manifestations due to hypercalcemia resulting from empirical treatment with high doses of vitamin D. We discuss the management strategies in these cases along with a brief review of the literature. 

Our first case was a 10-month-old infant who presented with fever, vomiting, and failure to thrive. Our detailed clinical examination and investigation revealed hypertension and bilateral nephrocalcinosis along with urinary tract infection. The second child was a 2-year-old girl with severe hypercalcemia with clinical features mimicking acute bacterial meningitis. The third infant had mild symptoms like constipation and irritability, and investigations showed moderate hypercalcemia. All had a history of inappropriate vitamin D administration, either in oral or parenteral form, and they were all successfully treated.

These case series highlight the importance of proper dosage, avoidance of parenteral route, along with appropriate clinical and biochemical monitoring during the course, whenever a dose of vitamin D is advised.

Sarcoidosis is a multisystemic granulomatous disease of unknown etiology. Renal involvement in sarcoidosis patients is occurred, but the incidence and prevalence is uncertain. The most common renal involvement of systemic sarcoidosis is nephrocalcinosis and interstitial nephritis. After sarcoidosis was diagnosed in a 31-year-old male patient, we performed a renal biopsy because of nephrotic range proteinuria and renal dysfunction. The collapsing variant of focal segmental glomerulosclerosis (FSGS) secondary to sarcoidosis was diagnosed by kidney biopsy.

 Primary hyperparathyroidism (PHPT) is a rare condition in the pediatric population. Parathyroid carcinoma (PC) is a very uncommon cause of PHPT, accounting for < 1% of pediatric PHPT cases. It is challenging to distinguish between parathyroid adenoma (PA), the most common cause of PHPT, and parathyroid carcinoma. In this report, we described a young female who presented with a history of progressive limping and was finally diagnosed with PC.

 A 15-year-old girl presented with progressive limping and bone pain for 8 years. She was referred by an orthopedic surgeon because of elevated intact parathyroid hormone (iPTH) for further evaluation. Physical examination revealed a large, firm, and non-tender neck mass, left hip tenderness, and limited range of motion. The initial biochemistry tests showed a borderline high calcium level of 10.8 mg/dl, an elevated iPTH level of 2876 pg/mL, and a decreased phosphorus level of 2.4 mg/dL. The 99mTechnetium (Tc) sestamibi scan displayed early intense activity in the right thyroid lobe persisting in the three-hour repeat scan, compatible with a parathyroid lesion. The patient underwent right-sided neck exploration and parathyroidectomy. Intraoperative and pathology findings confirmed the diagnosis of PC. Immunohistochemistry (IHC) staining revealed creatine kinase (CK) and CD31 in endothelial cells of the tumor. Ki67 staining was also positive in 2% - 3% of tumor cells. The whole exome sequencing (WES) study was negative for cell division cycle 73 (CDC73) and multiple endocrine neoplasia 1 (MEN1) genes.

 PC should be considered as a differential diagnosis of PHPT in the pediatric population, even in the presence of mild hypercalcemia.

Parathyroidectomy, the standard treatment of primary hyperparathyroidism (PHP) due to parathyroid adenoma, is not suitable for all patients. We evaluated the efficacy of ultrasound‑guided ethanol ablation of parathyroid adenoma in a group of patients with PHP.

In a prospective self‑controlled trial, 39 patients with parathyroid adenoma, who were not candidates for surgery, were enrolled. Ethanol injections were performed by two experienced interventional radiologists under the guidance of real‑time ultrasonography. Adenoma size changes were assessed at about 1 month later. Serum levels of parathyroid hormone, calcium, phosphate, 25‑OH Vitamin D, and alkaline phosphatase were evaluated at the baseline, 1, 3, 6, and 12 months after the injections. The treatment effects on outcome variables were assessed by repeated measures analysis.

Volume of the adenomas decreased during the study period from 1.87±6.45 cm3 to 0.38± 0.48cm3 (P < 0.001). Corrected serum calcium levels decreased from 10.40 ± 0.96 mg/dl to 8.82 ± 0.58 mg/dl (P < 0.001), and remained stable during one year follow‑up. Serum levels of parathyroid hormone decreased gradually from 129.85 ± 63.37 to 72.58 ± 53.86 pg/mL after 3 months and to 44.78 ± 28.04 pg/mL after 1 year (P < 0.001). Overall, 46% of the patients improved after 1 month of ethanol ablation therapy which increased to 84.5% during 1‑year follow‑up. No major complications were observed.

The current study showed the efficacy of ultrasound‑guided ethanol injection in PHP and may be considered as a suitable alternative treatment in patients who are not candidates for the surgery. It has also a good safety profile without major complications if performed by experienced hands.

Acute Lymphoblastic Leukemia (ALL) is a type of leukemia that generates from white blood cells in the bone marrow. ALL could present with different nonspecific symptoms. Hypercalcemia is a rare presentation in B-cell ALL. We reported a middle-aged man presented with hypercalcemia and osteolytic bone lesions without bone pain and a definitive diagnosis of B-cell ALL.

Persistent hypercalcemia and hyperparathyroidism after successful kidney transplantation can be detrimental in some recipients and should be ameliorated.

To point out the concerns regarding resistance to cinacalcet in kidney transplant recipients with persistent hypercalcemia.

14 renal transplant recipients who received cinacalcet treatment because of persistent hypercalcemia were included in the study. Serum creatinine, estimated glomerular filtration rate (eGFR), calcium, phosphorus, and intact parathyroid hormone (PTH) levels at the baseline and throughout the treatment, and ultrasonography and parathyroid scintigraphy findings were recorded.

Cinacalcet treatment was initiated after a mean±SD of 20.7±19.7 months of transplantation and maintained for 16.9±7.9 months. Serum calcium levels were significantly decreased with the cinacalcet treatment. There were no significant changes in serum creatinine, eGFR, phosphorus, and PTH levels. In all participants, serum calcium levels were increased from 9.8±0.6 to 11.1±0.6 mg/dL (p<0.001) within 1 month of cessation of cinacalcet. 7 recipients with adenoma-like hyperplastic glands underwent parathyroidectomy (PTx) due to failure with cinacalcet.

Cinacalcet may be an appropriate treatment for a group of recipients with hypercalcemia without adenoma-like hyperplastic glands or who had a contraindication for surgery. Recipients with enlarged parathyroid gland may resist to cinacalcet-induced decrease in serum PTH, although the concomitant hypercalcemia may be corrected.

Multiple myeloma (MM) is a clonal B-lymphocyte neoplasm of terminally differentiated plasma cells. Imaging modalities which allow the recognition of the effects of myeloma cells on the skeletal system have been utilized for a long time. Herein, we represent a patient with generalized osteoporosis and hypercalcemia, who was referred for parathyroid scan, in whom the widespread bone marrow technetium-99m-methoxy-2-isobutylisonitrile (99mTc-MIBI) uptake suggested the presence of a bone marrow involving pathology, which turned out to be multiple myeloma on bone marrow biopsy. The current case report highlights the importance of 99mTc-MIBI scintigraphy, with a relatively low cost and better accessibility compared with other high sensitivity modalities such as PET-CT, to be used to demonstrate multiple myeloma bone marrow involvement, which could incline physicians to consider 99mTc-MIBI scintigraphy as a complementary diagnostic tool for multiple myeloma.

Introduction. The frequency of kidney disorders varies in pulmonary sarcoidosis patients. Since the prevalence of kidney disorders among Iranian sarcoidosis patients is uncertain, this study aimed to evaluate kidney disorders and associated manifestations in Iranian pulmonary sarcoidosis patients. Materials and Methods. One hundred patients with confirmed granuloma as pulmonary sarcoidosis were studied for renal disorders. Size of urinary tract and the presence of renal stones were checked via clinical examination and urinary organ ultrasonography. Patients' 24-hour urine sample was examined for pH, calcium, protein (over 250 mg) and creatinine (over 1.4 mg). Results. Thirty-three percent of the patients expressed renal disorders simultaneously.Uric acid in pulmonary sarcoidosis patients could be correlated with the probability of developing renal stone. In addition, 1,25-dihydroxyvitamin D levels above 30 ng/mL and uric acid levels above 7 mg/dL in urine were directly correlated with renal disorders in sarcoidosis patients.
Conclusions. Urinalysis is an easy and reliable method for assessing renal disorders in sarcoidosis patients. The current study proposes inclusion of urinalysis in routine checkups of sarcoidosis individuals.

Thyroid follicular cancers are one of the thyroid gland cancers. This cancer can lead to metastases to various areas of the body. We describe a patient with thyroid follicular carcinoma who after total thyroidectomy had severe hypercalcemia, increased creatinine, and thyrotoxicosis due to extensive bone metastases. The patient was a 52‑year‑old man who had femoral neck fracture as the first manifestation of thyroid cancer. He was hospitalized for some time after orthopedic measures because of thyrotoxicosis and deep‑venous thrombosis. The study found that the origin of metastatic lesions was thyroid follicular cancer, leading to extensive bone metastases. After administering of methimazole and control of thyrotoxicosis, he was subjected to total thyroidectomy. Methimazole was discontinued immediately after surgery. One month after surgery, ultrasound confirmed that the thyroid was completely removed. However, T3 (triiodothyronine) remained high; besides the patient had hypercalcemia and increased creatinine due to dehydration. The patient was retreated with methimazole due to thyrotoxicosis, and for hypercalcemia fluid therapy, intravenous zoledronic acid was prescribed. These measures led to the normalization of creatinine and glomerular filtration rate. The purpose of introducing this case report was that these symptoms are a rare manifestation of functional metastases of follicular thyroid carcinoma after total thyroidectomy. Bone metastases of follicular thyroid carcinoma may be functional and are lytic that can lead to hypercalcemia and its complications.

Extraosseous accumulation of technetium-99m-methyl diphosphonate (99mTc-MDP) on bone scan is not common. This phenomenon is often attributed to abnormality of calcium metabolism and has been reported in a variety of conditions including metabolic diseases and malignancies.
A five years old boy is presented here, who was admitted to the pediatric emergency suffering from fatigue, respiratory symptoms, weight loss, intermittent fevers, anorexia, nausea and vomiting, edema of legs and abdominal distension for one month. The initial laboratory analysis revealed hypercalcemia. The patient was referred for whole body bone scan with suspicion of malignancy and bone metastasis. The bone scan revealed highly increased radiotracer uptake in both lungs in the perfusion and blood pool phases. Delayed images also showed increased activity in lungs and gastric wall. The skeleton was not seen clearly. Bone marrow aspiration was done and established the diagnosis of ALL. The patient deceased due to respiratory failure 20 days later.
Diffuse lung uptake in this patient was consistent with respiratory failure and poor prognosis. It is reported that bone scan may be useful for assessment of the extent of metastatic calcification and may establish suitable management to prevent organ failure.

The relationship between primary hyperparathyroidism and pancreatitis has yet to be established firmly. We present a patient with acute pancreatitis and a hypercalcemic crisis induced by a parathyroid adenoma. A 72-year-old woman presented with lethargy and a constant pain in the epigastric region. She had a medical history of diabetes mellitus, hypertension, nephrolithiasis, and ischemic heart disease. Blood examination revealed leukocytosis and high serum amylase and lipase levels. Ultrasound exam confirmed the diagnosis of acute pancreatitis with a normal biliary tract and no gallstones. On further evaluation severe hypercalcemia (24 mg/dL) was detected, which was treated with 0.9% sodium chloride solution and calcitonin. The acute pancreatitis and its symptoms resolved after 3 days. Ultrasound exam and technetium 99 m sestamibi scan showed a parathyroid lesion. Ultimately the patient underwent right thyroid lobectomy because of refractory hypercalcemia. The pathology report was indicative of a parathyroid adenoma. Subsequently, the parathyroid gland was resected with normalization of calcium, parathyroid hormone, and amylase levels and the patient was discharged in good condition 7 days after surgery. Apart from the acute supportive management, common to all cases of acute pancreatitis, definite management must be tailored to the specific cause. Hypercalcemia during the course of pancreatitis must prompt an investigation for primary hyperparathyroidism with early surgical intervention if a parathyroid source is detected.

The standard treatment for symptomatic primary hyperparathyroidism due to parathyroid adenoma is surgery, but in patients who are not good candidates for surgery, other treatment modalities including ethanol ablation, laser ablation, ultrasound wave ablation, and radiofrequency ablation are used. We describe a patient with multiple medical problems and a parathyroid adenoma who was treated with radiofrequency ablation.
A 47-year-old patient was referred to our hospital (Namazi hospital, Shiraz, Iran) in April, 2015 with intracranial hemorrhage, as well as high serum calcium and PTH (parathyroid hormone) levels (12.1 mg/dL and 1062 pg/mL, respectively), who had a parathyroid adenoma. Radiofrequency ablation was performed for the patient after he was stabilized, and three days later, his serum calcium and PTH levels decreased to 8.9 mg/dL and 38 pg/mL, respectively, and there was abnormal uptake according to the post-ablation parathyroid scan. The patient was followed for 12 months in our endocrine clinic, during which time he was in good general condition, with normal serum calcium, phosphate, and parathyroid hormone levels.
Radiofrequency ablation may be used successfully in the treatment of parathyroid adenoma when a patient cannot tolerate surgery.