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

Multiple myeloma has many unusual manifestations, which may obscure the true cause and delay proper treatment. Physicians in all specialties should be alert to this possibility, since myeloma may be at the root of such diverse disorders as carpal tunnel syndrome, peripheral neuropathy, solitary lytic bone lesions, hypercalcemia, and hyperviscosity syndrome.
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PMID:Unusual presentations of multiple myeloma. 85 84

Hypercalcemia of multiple myeloma has been discussed widely in the medical literature. The role of calcitonin and phosphate in the treatment of hypercalcemia of multiple myeloma has not yet been studied to our knowledge, although experimental animal models have been pointing to the role of phosphate supplement to calcitonin treatment in multiple myeloma. A patient had multiple myeloma and hypercalcemia. The usual medical treatment for hypercalcemia failed; however, the treatment with combined orally administered phosphate and calcitonin was successful. The role of phosphate depletion in this setting is brought up as an important factor in the failure of calcitonin therapy.
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PMID:Combined calcitonin and oral phosphate treatment for hypercalcemia in multiple myeloma. 87 32

Three patients had primary hyperparathyroidism and monoclonal serum immunoglobulins. Although multiple myeloma was suspected in each case, subsequent evaluation was consistent with a "benign monoclonal gammopathy". Parathyroid adenomas were removed from two patients. The three patients are presented and compared to the four other cases that have been reported previously. The association between primary hyperparathyroidism and benign monoclonal gammopathy is discussed in terms of possible pathogenetic mechanisms. Primary hyperparathyroidism should be suspected in patients with hypercalcemia and benigh monoclonal gammopathy, as well as in other conditions, like multiple myeloma, that are known to be associated with hypercalcemia.
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PMID:Primary hyperparathyroidism and benign monoclonal gammopathy. 90 Oct 89

This patient had an acute onset of myeloma, with hypercalcemia, a high M-component in the plasma, Bence Jones proteinuria, and 37% plasma cells in the bone marrow sample. After melphalan treatment (210 mg totally) he seems to have a complete cure, with total disappearance of the M-component, Bence Jones proteinuria, myeloma cells, hypercalcemia and elevated ESR for almost three years.
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PMID:Acute myeloma. 93 83

The clinical, haematological and biochemical correlations of 224 consecutive unselected examples of monoclonal gammopathy have been studied. The paraprotein frequency detedted was IgG 62 percent, IgA 15.2 percent, IgM 10.3 percent, Bence Jones protein 8.9 percent and in 3.6 percent the paraproteins were not identified. In half the monoclonal gammopathy was associated with an immunocytoma (myeloma in 82 and lymphoma in 30). In three cases the associated clinical disease was amyloidosis. In 36 cases (16.1 percent) the associated clincial disease was a nonlymphoproliferative malignant tumour. Monoclonal gammopathy may be a significant marker of malignancy in such cases. In 73 cases (32.6 percent) the associated clinical conditions were unrelated to the gammopathy although only 55 of these cases were sufficiently investigated to warrant classification as examples of benign monoclonal gammopathy. There was a strong correlation between Bence Jones proteinuria and malignancy. Sixty-five patients demonstrated Bence Jones proteinuria and in 59 of these a malignancy was detected. The association was strong between hypercalcaemia and malignancy as this was present in all 27 of the cases who had hypercalcaemia. The relationship between Bence Jones proteinuria and hypercalcaemia was also strong and Bence Jones proteinuria was detected in 73 percent of the hypercalcaemic patients as opposed to 36.7 percent in the whole series. Hypercalcaemia and Bence Jones proteinuria, when found in a patient with monoclonal gammopathy have a grave clinical connotation.
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PMID:Immunocytoma, cancer and other associations of monoclonal gammopathy: a review of 224 cases. 105 67

A review of 869 cases of multiple myeloma seen at the Mayo Clinic from 1960 through 1971 revealed that 98% of patients were 40 years of age or older and that 61% of them were males. Inital findings were bone pain in 68% of patients, anemia in 62%, renal insufficiency in 55%, hypercalcemia in 30%, a palpable liver in 21%, and a palpable spleen in 5%. Proteinuria was noted in 88% and Bence Jones proteinuria was identified in 49%. Skeletal roentgenographic abnormalities were seen in 79%. Serum protein electrophoresis showed a spike in 76%, hypogammaglobulinemia in 9%, and minor or no abnormalities in 15%, and a globulin spike was seen 75% of the urinary electrophoretic patterns. Immunoelectrophoresis of the serum revealed a monoclonal heavy chain in 83% and a monoclonal light chain in the serum, in 8% (Bence Jones proteinemia). Three patients had no monoclonal protein in the serum or the urine ("nonsecretory"). Amyloidosis was found in 7% of the patients. Follow-up information was obtained in 99.7% ; 82% of the 869 patients have died. Infection and renal insufficiency were the most common specific causes of death. The median survival was 20 months; 66% of the patients were alive at 1 year and 18% at 5 years.
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PMID:Multiple myeloma: review of 869 cases. 1252 72

Virtually any malignancy may lead to hypercalcemia, but carcinoma of the breast, myeloma, and carcinoma of the lung are especially frequent offenders. A more difficult diagnostic problem is posed by the "silent" tumor which secretes a substance causing hypercalcemia. Foremost in this category are bronchogenic carcimona and hypernephroma.
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PMID:Hypercalcemia and malignant disease. 111 72

1. The clinical manifestations, laboratory data and renal histologic features of acute renal failure occurring in 14 patients with multiple myeloma are reviewed and contrasted with the data from 29 previously reported cases. 2. Whereas other reports have stressed the role of intravenous pyelography and dehydration in the development of acute renal failure in multiple myeloma, the most common etiologic factor in our experience was hypercalcemia (7 patients). Other factors included potentially nephrotoxic antibiotics (3 patients) and volume depletion (2 patients). Intravenous pyelography could be clearly implicated in ony one patient. 3. The unusually high incidence of Bence Jones proteinuria in these patients is consistent with the possibility that Bence Jones protein excretion is associated with an increased susceptibility to renal injury. This could be due to an adverse effect of Bence Jones proteins on the renal tubules or their tendency to precipitate in tubular lumina during periods of reduced tubular flow. 4. The prognosis of patients with multiple myeloma who develop acute renal failure is poor; only 5 of our 14 patients survived the early period of acutely impaired renal function, and 4 of these subsequently died within 2 months. Preventive measures particularly the prompt correction of hypercalcemia and volume depletion, are the most important aspects of patient management.
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PMID:Acute renal failure in multiple myeloma. 114 86

The effect of certain disease parameters on remission and survial time was evaluated in 482 patients with multiple myeloma treated with intermittent courses of melphalan-prednisone combinations. Increasing degrees of anemia, hypercalcemia, azotemia, and high serum myeloma protein levels were associated with progressive lifespan shortening. The short survival of patients with anemia and hypercalcemia was associated with short remissions in responding patients with these abnormalities. The extent of tumor mass was defined from specific laboratory parameters reported by Durie to be associated with large numbers of plasma cells. More advanced stages of myeloma were associated with higher frequencies and degrees of normal immunoglobulin depression. The response rate was not affected by the tumor mass grade, but increasing tumor mass was associated with a shorter lifespan. Greater degrees of tumor reduction were associated with longer remission and survival times. Patients in whom a marked tumor reduction was rapid had shorter survival and remission times than patients who responded more slowly.
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PMID:Prognostic factors in multiple myeloma. 117 23

Osteolytic lesions and pathological fractures are common in multiple myeloma. Because clodronate inhibits osteoclastic resorption, we did a randomised, controlled trial in 350 patients from 23 hospitals. All patients received standard melphalan-prednisolone, and were randomised to receive clodronate 2.4 g daily or placebo for 24 months. The proportion of patients with progression of osteolytic bone lesions was twice as high in the placebo group (n = 168 at baseline) than in the clodronate group (n = 168 at baseline) in an intention-to-treat analysis (24 vs 12%, p = 0.026). Progression of vertebral fractures was lower in the clodronate group, but the difference was not significant (30 vs 40%). Serum calcium and urinary calcium excretion decreased significantly in both groups, but the changes were greater in the clodronate group. The percentage of patients feeling no pain increased more in the clodronate group (from 24 to 54%, p < 0.001) than in the placebo group (from 29 to 44%, p < 0.01). Side-effects were similar in both groups. We conclude that clodronate is an effective and safe adjunct in the management of multiple myeloma. The drug delays osteolytic bone lesions, reduces the degree of hypercalcaemia and hypercalciuria, and decreases pain.
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PMID:Randomised, placebo-controlled multicentre trial of clodronate in multiple myeloma. Finnish Leukaemia Group. 809 68


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