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)

A radioimmunoassay of human calcitonin (HCT) has been developed, employing antibodies formed in response to a HCT-bovine gamma globulin conjugate. The assay is sensitive (lower limits of detection 30 pg/ml serum), reproducible, and specific for intact HCT and carboxyl-terminal fragments of HCT. Serum HCT was detected in 76% of 63 normal subjects (mean +/- S.E.M. = 72 +/- 7 pg/ml), and was increased in cord sera, as well as sera from patients with chronic renal disease and medullary thyroid cancer. Increased levels were observed during calcium infusion into normal subjects, but not in sera from pregnant women or subjects with chronic hypercalcemia. No significant correlation was observed between serum ionized calcium and HCT in sera from 147 hospitalized patients. These findings suggest the usefulness of this assay for further studies of conditions affecting calcitonin homeostasis.
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PMID:Human calcitonin radioimmunoassay: characterization and application. 88 68

Nonparathyroid humoral hypercalcemia is becoming an increasingly more common problem associated with carcinoma. Carcinomas of the head and neck may elaborate parathormone or parathormone-like humors that in the absence of bone metastases, renal disease, parathytoid tumors, or secondary hyperparathyroidism may produce hypercalcemia, which if unrecognized, complicates and prevents the appropriate management of the patient. This report deals with the production of parathyroid hormone and the first reported case, to our knowledge, of carcinoma of the larynx associated with nonparathyroid hypercalcemia.
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PMID:Production of parathyroid hormone by laryngeal cancer. Report of a case. 114 29

Alterations in renal calcitriol synthesis are important in the pathogenesis of secondary hyperparathyroidism in patients with progressive renal failure. Many of the manifestations of secondary hyperparathyroidism can be reversed by treatment with 1 alpha-hydroxylated vitamin D sterols, such as calcitriol and 1 alpha-hydroxyvitamin D3, but some studies suggest that such treatment accelerates the rate of progression of renal disease in patients with mild to moderate renal failure. Thus, calcitriol and 1 alpha-hydroxyvitamin D3 have been used infrequently in this group of patients. A review of more than 20 clinical reports indicates that the use of calcitriol or 1 alpha-hydroxyvitamin D3, in daily doses of 0.25-0.5 microgram, is rarely associated with hypercalcemia, hyperphosphatemia, or impairment in renal function. If such complications arise, they are usually reversible when treatment with vitamin D sterols is withdrawn and serum calcium levels return to pretreatment values. There is evidence that calcitriol impairs creatinine secretion by the renal tubule; thus, serum creatinine levels may increase and measurements of creatinine clearance may fall during calcitriol therapy in patients with mild to moderate renal failure without any change in true glomerular filtration rate. Daily oral doses of 0.25-0.50 microgram of calcitriol or 1 alpha-hydroxyvitamin D3 are well tolerated, and they can reverse the biochemical and histologic features of secondary hyperparathyroidism. Calcitriol therapy may be particularly valuable in patients recognized to be at higher risk of developing progressive secondary hyperparathyroidism as their renal failure slowly advances.
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PMID:The use of 1,25-dihydroxyvitamin D3 in early renal failure. 158 May 87

Over the last 25 years, the perceived clinical spectrum of primary hyperparathyroidism (HPT) has changed dramatically from a disorder characterized by severe bone and renal disease to one typically manifested by few or mild symptoms and little evidence of organ damage. Reasons for this change in spectrum include changing demographics (primary HPT is primarily a disease of the middle-aged and elderly), diffusion of medical knowledge leading to a higher index of suspicion, and improved clinical laboratory technology (especially inexpensive and accurate determination of serum calcium and parathyroid hormone). In the first 343 cases of primary HPT seen at the Massachusetts General Hospital, 57% had renal stones, 23% had hyperparathyroid bone disease, and less than 1% had no symptoms. By contrast, studies dating from the availability of automated serum calcium measurement found renal stones and hyperparathyroid bone disease in less than 5% of cases, and about half of cases had few or no symptoms. Most patients with primary HPT today have mild, nonspecific symptoms, such as weakness, fatigue, and mental depression, and such signs as arterial hypertension and osteopenia, and detection of their hypercalcemia is generally serendipitous. The mildness and slow progression seen in many cases of primary HPT has resulted in much controversy about appropriate management.
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PMID:Clinical spectrum of primary hyperparathyroidism: evolution with changes in medical practice and technology. 176 71

The criteria used in selecting patients with asymptomatic hyperparathyroidism (HPT) for surgery remain controversial. Do patients with asymptomatic HPT have less severe disease (smaller glands and less derangement of biochemistry) than those with symptoms? We studied a consecutive series of 111 patients with HPT surgically treated and compared the symptomatic patients (n = 83) and asymptomatic patients (n = 28). There were no significant differences between the two patient groups with respect to age, serum calcium, PTH (intact 1-84), and excised gland weights (adenomas). Hypercalcemia was cured in all patients. The natural history of mild or asymptomatic HPT is unknown, but we summarize the current knowledge relating to mortality, cardiovascular/renal disease, psychiatric and neuromuscular disorders, and bone disease. Symptoms of HPT do not correlate with the degree of biochemical and pathological derangement. Furthermore clinical assessment does not predict severity of disease and should not be the sole basis of selection for surgery. The results of surgery for primary HPT permit us to advocate a liberal approach to the selection of asymptomatic patients for operation.
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PMID:Asymptomatic primary hyperparathyroidism. 176 38

Urinary tract abnormalities are detected as incidental findings in 15% of skeletal scintigraphic studies. Several scintigraphic patterns denote these abnormalities. Bilateral diffuse increased uptake is found in patients who have undergone chemotherapy and those with hyperparathyroidism, hypercalcemia, and sickle cell disease. Bilateral diffuse decreased uptake occurs in patients with end-stage renal disease, extensive metastatic disease to the bone, and various hematologic disorders. Focal increased activity is associated with postoperative changes and effects from radiation therapy. Focal decreased uptake is caused by space-occupying lesions such as abscesses, cysts, and neoplasms. Abnormal size, shape, and position associated with abnormalities of the kidney and bladder can also be seen. Although these scintigraphic patterns are seldom suggestive of a definitive diagnosis, they are highly specific for urinary tract disease.
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PMID:Incidental detection of urinary tract abnormalities with skeletal scintigraphy. 188 12

We measured the serum parathyroid hormone (PTH) levels in 20 patients treated with continuous ambulatory peritoneal dialysis before and after oral treatment with 24,25-dihydroxyvitamin D3- 24,25(OH)2D3. This metabolite was given in addition to existing treatment with 1 alpha-OH-D3 and calcium carbonate. Administration of 24,25(OH)2D3 led to a significant decrease in PTH levels (intact molecule) from 382 +/- (SE) 65 to 245 +/- 54 pg/ml in 9 patients whose initial levels were extremely high (p = 0.01). No side effects were observed. On the average, calcium values were unchanged and within the normal range throughout the study period; however, a few episodes of mild asymptomatic hypercalcemia occurred which responded quickly to reduction of the calcium carbonate dosage. The present study suggests that oral administration of 24,25(OH)2D3 combined with 1 alpha-OH-D3 is safe and capable of suppressing the raised serum PTH levels of end-stage renal disease patients without the danger of significant hypercalcemia.
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PMID:Oral administration of 24,25(OH)2D3 suppresses the serum parathyroid hormone levels of dialysis patients. 189 92

A variety of tumors and nontumorous lesions were used to illustrate some of the biologic, clinical, and pathologic aspects of inappropriate or ectopic endocrine and metabolic syndromes that have musculoskeletal repercussions. It is clear, both from the discussion and case material, that many mechanisms of ectopic endocrine syndromes have yet to be clarified. Elaborate techniques are available for hormonal estimations, but their routine use is prohibitively expensive and relatively unrewarding. Cells of a given lesion may be functionally heterogeneous or may fail to elaborate active products in substantial amounts. Different cells may produce similar peptides, while the same cells can produce more than one. Despite these difficulties, recognition of ectopic endocrine syndromes remains crucial to diagnosis and patient management, and thus corroboration or correlation must often rest on a cruder basis. In fact, the clinical significance of basic laboratory data, e.g., PTH elevation, may vary, as PTH may be immunoreactive but biologically inactive. As another example, hypercalcemia associated with myeloma may be variously related to coexistent hyperparathyroidism, renal disease, dehydration, or humoral osteolysis. Therefore, roentgenographic evidence of bone destruction or skeletal stigmata of hyperparathyroidism imbues laboratory data with greater significance. Paraneoplastic syndromes are of particular concern to the radiologist, as multiple systemic manifestations, occurring either synchronously or metachronously, may suggest the presence of an underlying or unifying lesion or even of a specific type of neoplasm. They may precede detection of neoplasms by months to years and can develop at any time during their course. Paraneoplastic syndromes may, furthermore, parallel the course of a lesion and be used as indicators of remission or recurrence. Conversely, those unassociated with overt symptoms possess endocrine markers that can reinforce sometimes silent skeletal stigmata. Familiarity with representative secretory products influencing the musculoskeletal system per se may often clarify seemingly innocuous and sometimes asymptomatic skeletal findings. Alert imagers may, therefore, detect, infer, or suspect particular syndromes when they present in a specific sequence or mosaic. Conversely, when apprised of their existence, imagers should know where their related effects may be sought or anticipated. Such relationships, sometimes serendipitously discovered, may be valuable assets in clinical diagnosis and patient management in both suspected and unsuspected cases.
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PMID:Skeletal manifestations of ectopic or inappropriate endocrine and metabolic syndromes. 198 23

Kidney involvement by Non-Hodgkin's lymphoma is very common microscopically but rarely a cause of uraemia even when the parenchymatous involvement is considerable. Renal failure in cases of lymphoma is secondary to ureteral obstruction, hypercalcaemia, urate nephropathy, gammopathy or immunologically mediated nephrosis. This is a case where the patient presented to the ophthalmic O.P.D. with blurring of vision and admitted with full blown uraemia. He could not be saved and at autopsy, a gastrointestinal lymphoma was found in the caecum. His uraemia was due to massive parenchymatous involvement of the kidney, there being no ureteral obstruction, hypercalcaemia, urate or immunologically mediated nephropathy. Very few cases are reported in literature with such a presentation.
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PMID:Uraemia--a rare presentation of non-Hodgkin's lymphoma. 209 May 77

Fourteen of 39 dialysis patients (36%) became hypercalcemic after switching to calcium carbonate as their principal phosphate binder. In order to identify risk factors associated with the development of hypercalcemia, indirect parameters of intestinal calcium reabsorption and bone turnover rate in these 14 patients were compared with results in 14 eucalcemic patients matched for age, sex, length of time on dialysis, and etiology of renal disease. In addition to experiencing hypercalcemic episodes with peak calcium values of 2.7 to 3.8 mmol/L (10.7 to 15.0 mg/dL), patients in the hypercalcemic group exhibited a significant increase in the mean calcium concentration obtained during 6 months before the switch, compared with the mean value obtained during the 7 months of observation after the switch (2.4 +/- 0.03 to 2.5 +/- 0.03 mmol/L [9.7 +/- 0.2 to 10.2 +/- 0.1 mg/dL], P = 0.006). In contrast, eucalcemic patients exhibited no change in mean calcium values over the same time period (2.3 +/- 0.05 to 2.3 +/- 0.05 mmol/L [9.2 +/- 0.2 to 9.2 +/- 0.2 mg/dL]). CaCO3 dosage, calculated dietary calcium intake, and circulating levels of vitamin D metabolites were similar in both groups. Physical activity index and predialysis serum bicarbonate levels also were similar in both groups. However, there was a significant difference in parameters reflecting bone turnover rates between groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Etiology of hypercalcemia in hemodialysis patients on calcium carbonate therapy. 223 37


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