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

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

Serum calcium was prospectively studied in 50 consecutive patients with active pulmonary tuberculosis. Twenty-four of them (48%) developed hypercalcaemia during an observation period of at least 8 weeks. Maximal increase in serum calcium (corrected for serum albumin) occurred three weeks after initiation of treatment, by which time 28% of the patients were hypercalcaemic. The increase in serum calcium was followed by a spontaneous remission. Only two patients developed symptoms related to hypercalcaemia, which promptly responded to steroid administration. No patient received vitamin D supplements before or during the study. No correlation could be found between hypercalcaemia and either the presence of acid-fast bacilli in the sputum or the season of the year. There was a trend for higher serum calcium values in the patients with the more severe radiographic changes on admission. Hypercalcaemia in patients with pulmonary tuberculosis seems to be triggered by chemotherapy. However, the mechanism(s) by which anti-tuberculosis treatment affects calcium metabolism remains uncertain.
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PMID:Serum calcium during chemotherapy for active pulmonary tuberculosis. 688 47

We studied the prevalence of hypercalcaemia in 34 Chinese patients with pulmonary (n = 32) or miliary (n = 2) tuberculosis. None of these subjects were given vitamin D or calcium supplements. Plasma calcium levels were measured at presentation and at 1- to 2-monthly intervals after treatment. During the 6-month study period, two patients (6%) developed hypercalcaemia (plasma calcium greater than 2.51 mmol/l), as compared to figures of 16% to 28% in the United States and India. By correcting the plasma calcium to a normal albumin, five (15%) of our patients were hypercalcaemic, as compared to a figure of 48% in Greece. Apart from variations in methodology, discrepancies in the reported prevalence of hypercalcaemia in tuberculosis may be due to differences in sun exposure, and vitamin D and calcium intake.
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PMID:The prevalence of hypercalcaemia in pulmonary and miliary tuberculosis--a longitudinal study. 776 88

From January 1, 1978 to December 31, 1992, 37 patients underwent a completion pneumonectomy after a previous lobectomy (36 men and 1 woman; mean age, 60 years; range, 41 to 77 years). These account for 4.8% of 758 pneumonectomies. The purpose of the present study was to evaluate the operative results of completion pneumonectomy and long-term survival in patients with bronchogenic cancer. The initial lung resection had been performed for primary bronchogenic cancer in 23, metastatic thyroid adenocarcinoma in 1, and benign diseases in 13 (tuberculosis in 11, aspergilloma in 1, and bronchiectasis in 1). Completion pneumonectomy was required for bronchogenic cancer in 32 (15 stage I, 6 stage II, 11 stage III). One patient had relapsing metastatic thyroid carcinoma, 2 had bronchiectasis, and 2 had a venous infarction after lobectomy. Four patients (10.8%) died perioperatively of the following causes: 1 fatal intraoperative bleeding, 1 fatal postoperative bleeding, 1 pneumonia, and 1 malignant hypercalcemia. Median operative blood loss was 1,000 mL, and 19 patients experienced bleeding exceeding 1,000 mL (51%). Six patients had intraoperative vascular injury. Nonfatal surgical complications occurred in 9 patients (24%), including 5 clotted hemothoraces, 3 empyemas, and 1 bronchopleural fistula. Four patients had medical complications (2 pulmonary edemas, 1 sinus tachycardia, and 1 unexplained fever). Twenty-three had an uneventful straightforward recovery (62%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Early and long-term results after completion pneumonectomy. 764 30

A variety of abnormalities in calcium and vitamin D metabolism have been reported in patients with active tuberculosis (TB), including hypercalcaemia, hypercalciuria and increased sensitivity to vitamin D. In this article, the frequency and nature of these abnormalities and the importance of extrarenal 1,25(OH)2D production are discussed.
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PMID:Abnormal calcium and vitamin D metabolism in tuberculosis. 785 12

Antituberculous chemotherapy agents, particularly rifampicin and isoniazid, affect vitamin D metabolism and can create biochemical evidence of vitamin D deficiency. Vitamin D deficiency induces a state of resistance to parathyroid hormone. This study sought to explain the temporary resolution of hypercalcaemia and hypercalciuria, during antituberculous chemotherapy with rifampicin and isoniazid, in a subject with a surgically proven parathyroid adenoma and coincidental spinal tuberculosis. Serum ionized calcium, 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D, plasma parathyroid hormone, and 24-hour urine excretions of calcium, inorganic phosphorus and hydroxyproline were sequentially measured over a 3-year interval that included 18 months of antituberculous chemotherapy. Initial serum ionized calcium was 1.52 mmol/l (normal 1.20-1.35 mmol/l), 24-hour urine calcium excretion was 9.40 mmol/day (normal 1.25 to 7.50 mmol/day) and plasma intact PTH was 9.2 pmol/l (normal 0.0-4.5 pmol/l). During antituberculous chemotherapy the serum ionized calcium and 24-hour urine calcium excretion were normal but the plasma PTH rose to higher levels. Following completion of the chemotherapy, hypercalcaemia and hypercalciuria returned with levels similar to those observed pretreatment. Serum 25-hydroxyvitamin D was low at 6.25 nmol/l (normal 20 to 90 nmol/l) during antituberculous chemotherapy, but was normal before and after. Serum 1,25-dihydroxyvitamin D was normal throughout the 3-year interval. We conclude that the antituberculous chemotherapy induced relative vitamin D deficiency and resistance to parathyroid hormone action, thereby masking the hyperparathyroidism and hypercalcaemia until the chemotherapy was completed.
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PMID:Primary hyperparathyroidism masked by antituberculous therapy-induced vitamin D deficiency. 764 6

Hypercalcaemia is uncommon among patients with pulmonary tuberculosis in Hong Kong, possibly because of the low dietary calcium intake in this population. We report here a case of severe hypercalcaemia in a patient with miliary tuberculosis and impaired renal function. We suggest that tuberculosis should be excluded in any febrile patient with hypercalcaemia, particularly in countries where it is still a common condition and an important cause of hypercalcaemia.
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PMID:Severe hypercalcaemia associated with miliary tuberculosis. 800 59

The converging epidemics of tuberculosis and acquired immunodeficiency syndrome (AIDS) in the RSA and their expected catastrophic interaction afford an ideal opportunity for well-planned and essential research by clinicians, molecular biologists, epidemiologists and other health workers. The enigmatic relationship between tuberculosis, vitamin D and calcium is a field of study which should be considered urgently. An optimal vitamin D status not only assures sound calcium-phosphorus homeostasis, but is also essential for maximal immune competency. Hypovitaminosis D probably predisposes towards vulnerability to tuberculosis due to deficient monocyte-macrophage function. In contrast, hypervitaminosis D can correct this deficiency, but would do so at the cost of both B- and T-lymphocyte efficiency. One example of such a state is the endogenous over-production of activated vitamin D by gamma-interferon-activated monocytes, tissue macrophages and granulomatous tissue in tuberculosis. This would not only cause the coincidental hypercalcaemia, but may also complicate the effective co-ordination of monocyte-lymphocyte interaction and consequently compromise an appropriate immune response. It can reasonably be expected that the raised plasma interferon levels in the AIDS patient may trigger similar vitamin D-related pathophysiological processes. It is proposed that the ideal situation for enhanced vulnerability to tuberculosis in the AIDS patient will have been created if the known destructive effects of the human immunodeficiency virus on CD4-positive lymphocytes act synergistically with the vitamin D-mediated complications listed above.
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PMID:[The relationship between tuberculosis, vitamin D, potassium and AIDS. A message for South Africa?]. 804 2

Hypercalcaemia can occur in patients with tuberculosis. To further characterize the calcium and vitamin D metabolism in this disorder, serum calcium, 25(OH)D, 1,25(OH)2D and parathyroid hormone and the interrelationships between serum calcium, 25(OH)D and 1,25(OH)2D were compared in 24 untreated Chinese patients with culture-positive pulmonary tuberculosis and 24 age and sex-matched controls in Hong Kong. Albumin adjusted serum calcium was significantly higher in patients (2.33 +/- 0.07 compared with 2.20 +/- 0.09 mmol l-1, P < 0.001), despite a lower calcium intake (426 +/- 208 compared with 564 +/- 335 mg day-1). No significant group difference was found in serum 25(OH)D or 1,25(OH)2D concentrations. There was a positive correlation between serum 25(OH)D and 1,25(OH)2D concentrations in the patient group (r = 0.50, P < 0.02), but a negative one in the control group (r = -0.48, P < 0.05). Serum parathyroid hormone was significantly lower in patients (20.9 +/- 8.5 compared with 38.2 +/- 14.5 pmol l-1, P < 0.001). In the patient group, no correlation between the radiographic extent of disease and serum calcium or 1,25(OH)2D concentrations was seen. Our findings confirmed that serum calcium is raised in tuberculosis but the effect may be reduced by a low calcium intake and a low parathyroid hormone level. Although the calcium and vitamin D metabolism appeared to be altered in tuberculosis, no direct relationship between serum calcium and 1,25(OH)2D, was found.
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PMID:A study of calcium and vitamin D metabolism in Chinese patients with pulmonary tuberculosis. 810 70

Pneumocystis carinii infection is commonly seen in patients infected with HIV, and there is evidence of macrophage involvement in the disease process. Macrophage dysfunction can result in abnormal vitamin D metabolism as is often seen in a granulomatous disease such as sarcoidosis. This article describes a patient with AIDS who had P. carinii pneumonia and hypercalcemia and had elevated 1,25-dihydroxyvitamin D levels, the first such reported case in the literature. There was no other evidence of a granulomatous disease such as sarcoidosis or tuberculosis to account for this. It is suggested that the increase in 1,25-dihydroxyvitamin D level was secondary to P. carinii induced macrophage dysfunction. As the patient's P. carinii pneumonia resolved, his 1,25 dihydroxyvitamin D level normalized along with the resolution of hypercalcemia.
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PMID:Case report: hypercalcemia in a patient with AIDS and Pneumocystis carinii pneumonia. 823 87


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