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Query: UMLS:C0020437 (hypercalcemia)
 10,293 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a 47-year-old woman with a pancreatic mass associated with hypercalcemia and mental confusion, medical measures failed to restore her serum calcium level to normal. To do so, radical resection of a locally invasive vascular neoplasm arising from the body and tail of the pancreas was necessary. The neoplasm was a pancreatic islet-cell tumour. Serum parathormone assays demonstrated abnormally high secretion of a parathormone-like substance. Ectopic secretion of such substances from islet-cell tumours should be considered in association with refractory metabolic disturbances. In view of the often indolent clinical course of islet-cell tumours and the potential for life-threatening hormonal effects, biopsy confirmation of adenocarcinoma should be obtained before resorting to palliative surgical management of pancreatic neoplasms.
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PMID:Pancreatic islet-cell neoplasia, with secretion of a parathormone-like substance and hypercalcemia. 303 May 25

Three cases of bladder carcinomas associated with hypercalcemia were presented. Case 1: A 43-year-old male was diagnosed as having bladder carcinoma 2 years ago and treated in another hospital by partial cystectomy with uretero-vesiconeostomy of the left side. On March 6, 1985, in our clinic, he received a total cystectomy with an ileal conduit for urinary bladder carcinoma. A 5-month post-operative clinical examination showed recurrence of the carcinoma with elevated serum Ca level (15.6 mg/dl). He was treated with eel-calcitonin, predonine, indomethacin, and furosemide, but died on August 23, 1985. Autopsy disclosed carcinoma of the urinary bladder (transitional cell cancer much greater than squamous cell cancer). Case 2: A 51-year-old male was diagnosed as having transitional carcinoma of the urinary bladder and was treated in our clinic by total cystectomy with cutaneous ureterostomy. Three months after the operation, he was readmitted with complaints of anorexia and disturbances of consciousness. His serum Ca level was elevated (17 mg/dl), and clinical examination showed recurrence of the carcinoma; bone scan revealed no metastasis. He was treated by radiotherapy with eel-calcitonin, predonine, indomethacin, and furosemide, but died on October 22, 1985. Autopsy disclosed carcinoma of the urinary bladder (squamous cell cancer). Case 3: A 72-year-old male was diagnosed as having a large urinary bladder tumor. An IVP showed a left non-functioning kidney. On admission, he complained of anorexia and confusion. His serum Ca level was elevated (13.8 mg/dl); bone scan revealed no metastasis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Bladder carcinoma associated with hypercalcemia: report of 3 cases]. 328 51

Endocrine disorders affecting the elderly present a continuing challenge to the clinician. Often confused with normal age-related changes or age-prevalent disease, disorders such as thyrotoxicosis, hyperglycemia, and hypercalcemia often go undetected until late in their course, if at all. Non-specific and atypical presentations make the diagnosis even more difficult and a low threshold for obtaining laboratory testing is advised. Thyrotoxicosis may present with only anorexia, weight loss, and cardiac dysfunction. Hyperglycemia often remains undetected; long-term sequelae, however, may impair function and result in problems such as neuropathy, postural instability, and nephropathy--conditions often dismissed as consequences of old age. Hypercalcemia may not present with the classic findings of renal colic, GI pathology, and skeletal disease. An acute confusional state with or without volume depletion appears to be a more frequent presentation during later life.
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PMID:Atypical presentation of endocrine disorders in the elderly. 338 39

An elderly man was admitted to the hospital with a large squamous cell carcinoma involving the right side of the chest wall. The patient was severely confused, and evaluation revealed pronounced hypercalcemia. With total surgical removal of the tumor, the serum calcium level fell to normal and his confusion cleared. Although hypercalcemia has been reported in association with a number of malignant tumors, including metastatic squamous cell carcinoma, this finding has been encountered only rarely with squamous cell carcinoma localized to the skin. The secretion of transforming growth factor or of another humoral substance has been postulated as the possible cause of hypercalcemia in this patient.
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PMID:Cutaneous squamous cell carcinoma and hypercalcemia. 362 78

A hypercalcemic condition can be observed in association with hyperthyroidism. The case of a patient suffering from hypercalcemia and hyperthyroidism is reported. A confusional state and EEG alterations, among which diffuse monomorphic delta rhythms were remarkable, are shown. As soon as normalization of calcemia was achieved, a rapid clinical and EEG improvement took place. A hypothetical interpretation is proposed, according to which a prolonged, though inconstant, and mild hypercalcemia in the course of hyperthyroidism could determine an encephalopathy, concealing in some way thyrotoxic symptoms.
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PMID:Hypercalcemic encephalopathy in the course of hyperthyroidism. 397 17

207 hypercalcaemic patients, discovered in an urban area of 1 million people over a period of 5 months, were examined to determine the current incidence and mode of presentation of primary hyperparathyroidism. Primary hyperparathyroidism was diagnosed in 111 patients and those most at risk were women over the age of 70 (55% of all patients). In 57% of all patients the initial indication of primary hyperparathyroidism was hypercalcaemia found unexpectedly on biochemical screening of the serum. The next most common mode of presentation was an acute hypercalcaemic syndrome in elderly patients, characterised by confusion and dehydration (14% of all patients). Modern diagnostic methods and routine estimations of serum calcium can be expected to yield at least 250 new cases of primary hyperparathyroidism per million population per year.
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PMID:Primary hyperparathyroidism: changes in the pattern of clinical presentation. 610 28

Between September 1975 and June 1980, 27 patients with primary hyperparathyroidism caused by multiple-gland disease underwent reoperative parathyroid surgery at the National Cancer Institute. In an effort to minimize persistence and recurrence we adopted a strategy of attempting total parathyroidectomy. Immediate autotransplantation was not performed, but rather tissue was assessed in vitro for suppressibility and was cryopreserved. Patients with prolonged postoperative hypoparathyroidism underwent autotransplantation with cryopreserved tissue. Of 26 surviving patients, 23 (88%) were cured of hypercalcemia. Although 13 had hypoparathyroidism at the time of discharge, 4 of these 13 no longer required calcium or vitamin D within 1 year. At follow-up 17 were normocalcemic without medication (14 without and 3 with autografts). Thirteen patients had four or five glands removed. Two of these remain hypercalcemic, and at follow-up nine were normocalcemic without medication (seven without and two with autografts). Patients with multiple-gland disease, even those undergoing total parathyroidectomy, remain at risk for persistent or recurrent hypercalcemia. Such patients do no inevitably acquire hypoparathyroidism, and normocalcemia in patients undergoing immediate autotransplantation need not be attributed to the autograft. Selective, deferred autotransplantation with cryopreserved tissue prevents confusion regarding the source of postoperative hypercalcemia should it occur, minimizes the risk of graft-dependent hypercalcemia by restricting autotransplantation to those truly in need of additional tissue, and can effectively manage hypoparathyroidism.
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PMID:Reoperative parathyroid surgery for primary hyperparathyroidism caused by multiple-gland disease: total parathyroidectomy and autotransplantation with cryopreserved tissue. 612 56

A confusional state due to hypercalcemia led to the discovery of multiple myeloma in a 73 year old man. The recurrence of a confusional state, related to plasma cell meningitis called for hospitalization. Serum, urine and cerebrospinal fluid immunoelectrophoresis revealed monoclonal immunoglobulines of lambda light chains. The pathologic study showed an invasion of the subarachnoid space by abnormal plasma cells. The dura mater and brain substance were not invaded. The leptomeningeal invasion by multiple myeloma plasma cells in a rare occurrence. We have found only three such cases published before. The analysis of our case and the three other leads to some comment. The clinical features are those of chronic meningitis revealed by a confusional study or epilepsy. The existence of abnormal plasma cells in the cerebrospinal fluid and their absence in the blood stream seems to suggest a local production of these cells. The histopathological study confirmed, in our case as in the others published, the massive invasion of the subarachnoid space by plasma cells while the dura mater is not invaded.
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PMID:[Plasmocytic meningitis in multiple myeloma. An anatomo-clinical observation]. 688

A case of acute hypervitaminosis A complicating viral hepatitis is reported. Twenty days after presenting with hepatitis B, a 42-yr-old vegetarian developed acute hypervitaminosis A in the absence of recent, massive exposure to the vitamin. Findings included headache, confusion, skin desquamation, and hypercalcemia. Prior to developing hepatitis, he had ingested supplemental vitamin A without recognized ill effect. Liver and serum vitamin A without recognized ill effect. Liver and serum vitamin A levels were both elevated; the liver biopsy showed abundant, lipid-filled Ito cells and perisinusoidal fibrosis. This case demonstrates that patients with excessive hepatic stores of vitamin A may develop hypervitaminosis A during acute, intercurrent liver disease. Levels of retinol binding protein are reduced in hepatitis. This phenomenon may account for the findings in this case, since vitamin A is more toxic when not specifically bound to retinol binding protein. The size of the population at risk for this complication of hepatitis in unknown, but presumably it is growing with the widespread use of supplemental vitamin A.
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PMID:Hypervitaminosis A unmasked by acute viral hepatitis. 719 70

A 36-year-old with end-stage renal disease secondary to hypertensive nephrosclerosis had a two-day history of epigastric pain and nausea. Soon after admission, multiple grand mal seizures uncontrolled by intravenous phenytoin sodium and diazepam developed. His calcium level was 14 mg/dL and his amylase level was 2,230 mg/dL; lumbar puncture was normal. Hemodialysis lowered his calcium level to 10.7 mg/dL but failed to control his seizures. Secondary hyperparathyroidism was thought to be the cause of his malignant hypercalcemia, and an emergency subtotal parathyroidectomy was performed. Postoperatively, his grand mal seizures resolved. Confusion and aphasia also developed, but they resolved over the ensuing three weeks. Microscopic examination of the parathyroid glands revealed diffuse chief cell hyperplasia. Preoperative parathormone level was 2,196 pg/dL (normal, less than 450 pg/dL). A review of the literature has failed to reveal a similar case.
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PMID:Secondary hyperparathyroidism manifesting as acute pancreatitis and status epilepticus. 728 72


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