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

Bile duct carcinoma is reported in a 50-year old man as a rare late presentation of congenital hepatic fibrosis (CHF). A survey of the world literature suggests that carcinoma occurs with increased frequency in congenital biliary dilatation. It appears to be a particular risk in patients with prolonged survival but is rare in CHF, where portal hypertension and renal insufficiency make the long-term prognosis poor. In this patient the absence of both gastroesophageal varices and renal disease may have permitted longevity with development of carcinoma. The finding of carcinoma arising in the bile ducts distal to the basic lesion of CHF suggests that active carcinogens may be present in the bile in CHF. The tumor in this patient was unusual in producing mucinous biliary obstruction and terminal hypercalcemia.
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PMID:Bile duct carcinoma: a late complication of congenital hepatic fibrosis. Case report and review of literature. 624 19

Impairment of urine-concentrating ability is common in persons with chronic hypercalcemia. We assessed urine-concentrating ability in 40 patients with typical primary hyperparathyroidism and 10 patients with familial hypocalciuric hypercalcemia, a disorder resembling typical primary hyperparathyroidism but lacking some of its clinical complications. Urine-concentrating ability was determined during a dehydration test of 18-22 h. The two patient groups were comparable with respect to serum calcium concentration and creatinine clearance. In the group with familial hypocalciuric hypercalcemia, the duration of hypercalcemia was probably greater, because it commences during infancy; the urinary excretion rate for calcium was lower [6.6 +/- 5.4 (mean +/- 1 SD) vs. 14.8 +/- 7.5 meq/day; P less than 0.005]. Patients with familial hypocalciuric hypercalcemia showed higher maximal urinary osmolality (800 +/- 150 vs. 664 +/- 130 mosmol/kg; P less than 0.0005). Among the patients with typical primary hyperparathyroidism, there was a negative association between maximal urinary osmolality and urinary cAMP (r = -0.40; P less than 0.05), but there was no significant relation between maximal urinary osmolality and the urinary excretion rate for calcium. Among 18 patients retested within 1 month after surgical correction of typical primary hyperparathyroidism, urine-concentrating ability did not improve. In patients with typical primary hyperparathyroidism, impairment in urine-concentrating ability reflects features of the chronic disease state, as it is not rapidly reversible by correction of that state. However, in patients with familial hypocalciuric hypercalcemia, longstanding hypercalcemia is not associated with obvious impairment of urine-concentrating ability. Complete or partial freedom from impairment of urine-concentrating ability and from calcareous renal disease are expressions of the generally mild course in familial hypocalciuric hypercalcemia.
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PMID:Maximal urine-concentrating ability: familial hypocalciuric hypercalcemia versus typical primary hyperparathyroidism. 625 92

Sarcoidosis was found in three patients referred for etiologic diagnosis of chronic or rapidly progressive renal failure. One patient presented as an isolated interstitial nephropathy and renal biopsy showed granulomatosis. The two other patients had hypercalcemia. In one, hyperparathyroidism was discussed and cervicotomy disclosed a sarcoidosic adenopathy. Under corticosteroid therapy, renal function improved in each of the three patients. It is pointed out that accurate diagnosis of this setting is of significance since effective therapy is possible.
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PMID:[Sarcoidosis disclosed by renal insufficiency (3 cases)]. 631 43

The overall aim of this investigation was to study the function, anatomy and histopathology of the parathyroid glands, and different clinical aspects of parathyroid surgery, in relation to renal disease. The investigation was divided into six parts: The indications for parathyroidectomy and the clinical outcome after surgery in patients with secondary hyperparathyroidism (HPT) were analysed and a comparison was made regarding these aspects between subtotal parathyroidectomy (PTXsubtot) and total parathyroidectomy with autotransplantation to the forearm (PTXtrpl). The long-term function of autotransplanted parathyroid tissue was also assessed. The anatomy of the parathyroid glands and its implications for the strategy in parathyroid surgery were evaluated. A study was also made of the pathology of the parathyroids in patients with different stages of renal impairment. Furthermore, baseline biochemical and radiological data pertinent to the diagnosis of progressive secondary HPT and renal bone disease were obtained from a random sample of a population of uraemic patients and patients with kidney transplants, and analysed. It was found that both PTXsubtot and PTXtrpl are effective in reverting clinical symptoms and biochemical changes in secondary HPT. A recurrence is more easily managed, however, after PTXtrpl. It was also demonstrated that PTXtrpl constitutes a valuable method for restoring parathyroid function to normal as a long-term measure in patients with uraemia and secondary HPT. The anatomical study disclosed a high incidence of supernumerary glands. These glands were either located in the upper thymic horn or in the thyreo-thymic ligament or as rudimentary glands in the fat tissue surrounding the parathyroids. It is concluded that parathyroid surgery in patients with HPT secondary to uraemia should include a thymic resection and excision of fat tissue surrounding the parathyroids in order to avoid persistent or recurrent HPT. Histopathological signs of stimulation of the parathyroids were present even at subclinical levels of renal impairment, and increased in parallel with advancing renal disease. In patients with end-stage chronic renal disease all parathyroid glands were affected. Therefore, a radical operation, i.e. PTXsubtot or PTXtrpl should always be performed when uraemic patients with parathyroid disease are subjected to parathyroid surgery. Hypercalcaemia was the main indication for parathyroid surgery among our patients despite a low incidence of symptomatic renal bone disease. Since hypercalcaemia renders attempts at parathyroid suppression by pharmacological means impossible, and since the clinical outcome after parathyroid surgery was favourable in our series, early surgical intervention is recommended when secondary HPT cannot be controlled by conventional medical procedures.
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PMID:Secondary hyperparathyroidism in chronic renal failure. 635 Dec 38

One hundred and twelve randomly selected patients with renal disease (22 on conservative treatment, 35 on haemodialysis and 55 with functioning kidney transplants) were subjected to a longitudinal and follow-up study of biochemical and radiographic signs of secondary hyperparathyroidism (HPT). Special interest was directed towards diagnostic criteria leading to the decision to perform parathyroid surgery, which had been undertaken in 18 patients. The five patients selected for parathyroidectomy while on conservative treatment were clearly distinguishable from the rest of the patients in this group, on the basis of hypercalcaemia, massive elevation of serum parathyroid hormone and radiographic abnormalities, findings which did not occur in patients in whom parathyroid surgery had not been considered. Six patients underwent parathyroidectomy while on haemodialysis. Preoperatively hypercalcaemia was observed in five and this was the only finding separating these patients from non-operated patients. Radiographic abnormalities were observed in only one operated patient. After kidney transplantation, long-standing hypercalcaemia was observed in 27% of patients. Seven patients underwent parathyroidectomy, hypercalcaemia being the indication for surgery in all cases. Hypercalcaemic patients could not be separated from normocalcaemic patients regarding any other determined biochemical variable, or regarding the incidence of osteonecrosis of weight-bearing joints, which was found in 18% of transplanted patients, and which was the only cause of major symptomatic bone disease observed in this study. The findings of hypercalcaemia as a major deciding factor for parathyroid surgery, a low incidence of radiographic bone disease, and absence of major symptomatic bone disease referable to HPT, are in keeping with a more liberal attitude to parathyroidectomy in chronic renal disease than has been stated in other recent reports. With a more expectant attitude and with more active medical treatment some of the operations performed on the patients in this study might have been avoided but, in general, the favourable outcome after surgery and the low overall incidence of clinical problems referable to bone disease at our unit would seem to support our active approach to parathyroid surgery.
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PMID:An investigation of biochemical and radiographic signs of hyperparathyroidism in chronic renal disease. 639 21

The purpose of the present investigation was to study various aspects of renal bone disease in patients treated at a centre with a low general incidence of symptomatic renal osteodystrophy. In a study of signs of progressive secondary hyperparathyroidism (HPT) in a random sample of patients with chronic renal disease, symptomatic bone disease occurred only in transplanted patients with osteonecroses of major joints. Biochemical and radiographic signs of severe progressive HPT were comparatively infrequent. Hypercalcaemia was the major indication for parathyroid surgery. Normocalcaemic patients on haemodialysis (HD) investigated with dynamic bone histomorphometry showed normal mean bone formation rates. Serum PTH was a major determinant of bone remodelling activity. Histochemical evidence of bone aluminium accumulation was found in the majority, and the trabecular surface extent of aluminium was directly related to indices of defective mineralization. Long-term continuous ambulatory peritoneal dialysis (CAPD) was associated with normocalcaemia and acceptable control of hyperphosphataemia. Serum PTH remained high and radiographic evidence of progressive HPT developed in some patients. Histomorphometrical findings, including signs of aluminium accumulation, were similar to those in HD, indicating that CAPD has no specific effect on renal bone disease. Low serum 25-hydroxycholecalciferol in CAPD could not be related to specific findings regarding histomorphometry. Chronic haemofiltration (HF) was associated with a high risk of calcium loss and hypocalcaemia. Despite decreasing serum calcium serum PTH decreased, and bone biopsy findings indicated decreased skeletal effects of PTH as a further cause of hypocalcaemia. Bone histomorphometry also showed the development of a progressive mineralization defect probably related to calcium deficiency, while trabecular bone aluminium decreased in all patients during HF.
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PMID:Bone disease in renal failure. Clinical and histomorphometric studies. 639 22

Primary hyperparathyroidism was diagnosed in two German shepherd pups from a litter of four females. Clinical signs were apparent by two weeks of age and included stunted growth, muscular weakness, and polydipsia/polyuria. Radiography revealed diffuse reduction in bone density. Both pups had marked hypercalcemia, hypophosphatemia, increased plasma immunoreactive parathyroid hormone concentrations and increased fractional clearance of inorganic phosphate in the urine. Intravenous infusion of one affected pup with calcium gluconate failed to suppress the plasma concentration of immunoreactive parathyroid hormone, suggesting autonomous secretion of parathyroid hormone. Necropsy of the other pup at eight weeks of age revealed diffuse hyperplasia of parathyroid chief cells, nodular hyperplasia of thyroid C-cells, skeletal alterations consistent with fibrous osteodystrophy, hypercalcemic nephropathy, and extensive mineralization of the lungs and gastric mucosa. The dam and sire were half sibs. One male pup from a previous litter of six had developed similar clinical signs and radiographic lesions, suggesting autosomal recessive inheritance. This is the first report of hereditary primary hyperparathyroidism in domestic animals, a disease which may be analogous to hereditary neonatal primary hyperparathyroidism in children.
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PMID:Primary hyperparathyroidism in German shepherd dogs: a disorder of probable genetic origin. 646 98

Often the diagnosis "light chain nephropathy" is not made before renal failure has developed. In the past these patients had a poor prognosis. Special features of this disease and improvement of renal function by plasma exchange therapy are shown in a case report. A 51-year-old man admitted to hospital with renal failure, proteinuria and hypercalcaemia was treated by Ca-free dialysis and membrane plasma separation (MPS). Renal biopsy studied by light and electron microscopy showed mainly tubular protein casts. It is assumed that this nephropathy is caused by a direct toxic effect of the kappa light chains on function and structure of tubuli. Proteinuria was markedly lowered and renal failure was made partly reversible by prompt and effective MPS. Thus, MPS may improve the prognosis of this stage of disease.
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PMID:[Successful treatment of kappa light chain nephropathy using membrane plasma separation]. 650 15

Primary hyperparathyroidism and sarcoidosis were found in one patient with hypercalcemia and renal failure. Cervicotomy disclosed a parathyroid adenoma and renal biopsy demonstrated interstitial nephropathy. Association of sarcoidosis with hyperparathyroidism, if not fortuitous, has not yet been clearly established.
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PMID:[Hypercalcemic sarcoidosis and primary hyperparathyroidism disclosed by renal insufficiency]. 650 29

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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