Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020437 (hypercalcemia)
 10,293 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Myeloma is a malignancy of plasma cells that are terminally differentiated B-lymphocytes. The clinical spectrum varies from the incidental discovery of a pathologically raised monoclonal immunoglobulin on routine electrophoresis in asymptomatic patients to widespread skeletal involvement with incapacitating bone pain. Symptoms may result from a solitary tumor mass, described as an extramedullary plasmacytoma, in virtually any part of the body. Metabolic abnormalities commonly include hypercalcemia, elevated plasma urate levels, or the development of amyloidosis, all of which may disturb renal function. High paraprotein levels cause hyperviscosity, resulting in generalized debility and varying degrees of disturbed mental function. The natural history is determined by the mass of the tumor coupled with its unique biologic features. Median survival of unselected patients, without effective treatment but once symptoms are evident, is approximately 7 months; this period can be significantly prolonged with appropriate therapy. As a first step, urgent medical management is often necessary, centering on rehydration, correction of hyperviscosity, and reversal of metabolic defects, each of which may improve renal function. Over the longer term, specific antitumor drugs have extended median survival to approximately 30 months, and most regimens include a combination of melphalan and prednisone, with or without other cytotoxic drugs. Alternative forms of treatment include sequential hemibody irradiation, recombinant alpha interferon, and in suitably selected patients, high-dose chemoradiotherapy followed by bone marrow transplantation. The latter approaches offer promising management options and are currently the subject of evaluation in controlled clinical trials.
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PMID:Myeloma. 218 18

The major causes of renal insufficiency, present initially in half of the patients with multiple myeloma, are "myeloma kidney" and hypercalcemia. There is no reliable evidence that the isoelectric point (pI) or the type of light chain has an important role in renal failure. Acute renal failure must be treated vigorously with appropriate fluids and electrolytes as well as hemodialysis if necessary. The benefit of plasma exchange has not been proven. Primary systemic amyloidosis or light-chain deposition disease is the usual cause of the nephrotic syndrome in patients with monoclonal gammopathy. The monoclonal gammopathies are a group of disorders that are characterized by the proliferation of plasma cells producing a homogeneous, monoclonal protein (M-protein).
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PMID:Monoclonal gammopathies and the kidney. 249 46

A case of multiple myeloma (Bence Jones, lambda) associated with alcoholic liver cirrhosis is reported. A 56-year-old Japanese male died of hepatic failure and hypercalcemia. Autopsy revealed alcoholic liver cirrhosis and plasma cell myeloma. Immunoelectrophoretic analysis of his reserved serum disclosed the presence of M component of lambda Bence Jones protein. IgA and lambda light chain were demonstrated in the cytoplasm of the myeloma cells. Complications such as generalized amyloidosis, metastatic calcification, myeloma kidney and hemorrhagic pancreatitis were noted. The coexistence of multiple myeloma and liver cirrhosis has rarely been reported. On the basis of a review of the reported cases, a possible association between both diseases was discussed.
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PMID:Multiple myeloma in alcoholic liver cirrhosis. 265 75

Renal failure in patients with lymphoma or leukemia may be brought about by different causes, including ureteral obstruction, hypercalcemia, hyperuricemia, amyloidosis, immunologically mediated nephrosis and paraproteinemic nephropathy. Lymphomatous or leukemic infiltration of the kidneys is a frequent finding at autopsy but is rarely seen as a cause of renal failure. In this report three patients with lymphomatous infiltration of the kidneys causing renal failure are described. Clinical and laboratory criteria for establishment of diagnosis in such cases are suggested. Using these diagnostic criteria, a renal biopsy may not be necessary.
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PMID:[Renal insufficiency due to lymphomatous infiltration of the kidney: report of 3 cases and review of the literature]. 281 88

The term 'benign monoclonal gammopathy' indicates the presence of a monoclonal protein in persons without evidence of multiple myeloma, macroglobulinaemia, amyloidosis, lymphoproliferative disease, or other related disorders. The term 'monoclonal gammopathy of undetermined significance' (MGUS) is preferable because it is not known at diagnosis whether an M-protein will remain stable and benign or develop into symptomatic multiple myeloma or related disorders. Immunoelectrophoresis and immunofixation of the serum and urine are necessary to determine the presence and type of M-protein. At the Mayo Clinic, follow-up data have been gathered for more than 13 years on 241 patients with an initial benign monoclonal gammopathy. Nineteen per cent of these patients developed multiple myeloma, macroglobulinaemia, amyloidosis, or related diseases during the follow-up period. There is no reliable technique for differentiating a patient with a benign monoclonal gammopathy from one who will subsequently develop a serious disease. It is necessary to follow these patients indefinitely. Important in the complete understanding of the elderly patient with monoclonal gammopathy are the following: clinical manifestations, laboratory findings, and differential diagnosis of multiple myeloma; the course and prognosis and the induction therapy and treatment of multiple myeloma; newer therapeutic approaches; and the management of complications such as hypercalcaemia, hyperuricaemia, renal failure, bacterial infections, skeletal disease, and neurological problems.
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PMID:Monoclonal gammopathy and multiple myeloma in the elderly. 332 48

Diagnosis of multiple myeloma is based on the triad paraproteinemia, osteolytic bone lesions and bone marrow plasma cell infiltration. Clinically, rheumatoid-like pain induced by osteolytic skeletal lesions often prevails. Occasionally, foudroyant bacterial infections - the most frequent cause of death in myelomatosis - or acute/subacute renal failure or rarely, acute hemi- or paraparesis precede diagnosis. Establishment of diagnosis early in the course of the disease and improved cytostatic and symptomatic treatment has led to a decrease in episodes of hyperviscosity-syndromes. Severe renal insufficiency due to Bence-Jones proteinuria prevails in 20% of patients already at time of diagnosis. With increasing duration of the disease, frequency of renal insufficiency further increases. Hypercalcemia with consecutive dehydration and renal insufficiency usually is a complication of long-standing disease. Anemia, leukopenia and thrombo-cytopenia are not only side effects of cytostatic treatment, but also consequences of tumor-induced suppression of hematopoiesis. Polyneuropathies are common in myelomatosis. They probably are the result of specific and/or unspecific binding of paraproteins to myelin sheaths. Effective treatment for this complication is not available at present. Thrombohemorrhagic complications are more frequent in patients with myeloma than in the control group of other hospitalized patients. Non-secretory myeloma, osteoblastic myeloma and Takatsuki syndrome are variants of myelomatosis. Solitary and extramedullary plasmocytoma are different, potentially curable entities. Prognosis is especially poor in patients with plasma cell leukemia and poor in primary amyloidosis.
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PMID:[The clinical picture of multiple myeloma]. 353 47

Thirty-two patients with myelomatosis (3 with a solitary plasmocytoma and 29 with multiple myeloma) and neurological complications, from a group of 110 unselected patients with myelomatous disease were recorded. Spinal cord compression was the most frequent complication seen in 12 cases. In 9 subjects, it was the presenting symptom, and in 11 cases was caused by extradural plasmocytoma of the thoracic spine. Early decompressive laminectomy was curative in 3 cases, but in the rest, delay in diagnosis resulted in only partial recovery even with radiotherapy. Of the 6 patients with nerve root involvement, radiotherapy led to full recovery in 2 of 3 cases, and laminectomy resulted in complete improvement in 2 other cases. Peripheral polyneuropathy was seen in 8 cases, 2 related to systemic amyloidosis and 6 unassociated with amyloidosis. Both forms of neuropathy shared a slow progression, independent of the course of the myeloma. Acute encephalopathy, found in 6 cases, was due to hypercalcemia and/or serum hyperviscosity, and led to a significant shortening of mean survival. One patient had third cranial nerve palsy due to the overlying lesion of the skull base, and another suffered acute bacterial meningitis.
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PMID:The spectrum of neurological manifestations in myeloma. 386 89

Over a 14-year period, 26 patients with adrenal insufficiency of multiple etiology were evaluated. Eight were diagnosed at autopsy, six of whom had acute bilateral adrenal hemorrhage. Nine had chronic adrenal insufficiency. Of these, five were idiopathic and three had polyglandular disorders. Four others had tuberculosis. Six of nine patients with chronic adrenal insufficiency were hyperpigmented. Unusual manifestations of adrenal hypocorticism included hypercalcemia, flaccid paralysis, and joint contractures. The presence of multiple hormonal deficiencies focused the diagnosis on hypopituitarism. Two cases of isolated ACTH deficiency were detected. Patients with familial Mediterranean fever with amyloidosis commonly presented with reduced adrenal reserve rather than overt insufficiency. Metastatic cancer of the adrenal glands was a rare cause of reduced adrenal reserve.
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PMID:Adrenal insufficiency in a general hospital over a 14-year period. 608 24

A patient with multiple myeloma complicated by hypercalcemia is presented. During the state of an elevated calcium phosphate product a transient diffuse accumulation of Tc 99m MDP in the liver was demonstrable, whereas the demonstrated metastatic calcifications of the kidneys persisted after therapeutic reduction of the elevated ion product. This points to a difference in the formation of calcium phosphate precipitations in these organs. Accumulation of Tc 99m labelled bone seeking agents in the liver must not always mean severe liver damage or amyloidosis or tumour manifestation. An altered serum calcium phosphate balance has to be taken into account when interpreting scintigrams performed with bone seeking radiopharmaceuticals.
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PMID:Transient accumulation of Tc 99m MDP in the liver. 644 28

A patient with end-stage renal disease and hypercalcemia was referred for a radionuclide bone imaging study. Deposition of Tc-99m hydroxymethylenediphosphonate was apparent in the lungs and myocardium as well as in the skeleton. Renal uptake was also noted, despite anuria. Computed tomography demonstrated nephrocalcinosis but no myocardial calcification. The cause of myocardial uptake of tracer is unknown. Amyloidosis is suggested as a possibility but is not validated in this case.
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PMID:Myocardial uptake of a bone tracer associated with hypercalcemia. 650 34


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