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

Two patients with hypercalcemia and hyperthyroidism had elevated levels of parathyroid hormone (PTH). When the patients were made euthyroid with appropriate medical therapy, both the levels of PTH and calcium returned to normal. Since thyroid hormone can increase tissue responsiveness to catecholamines, and since catecholamines can stimulate PTH secretion, we postulate that the elevated levels of PTH were secondary to thyrotoxicosis. In patients with coexisting hyperthyroidism and hyperparathyroidism, primary hyperparathyroidism should only be diagnosed when the patient is eumetabolic.
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PMID:Thyrotoxicosis, hypercalcemia, and secondary hyperparathyroidism. 44 69

Malignant melanoma occurs in approximately 1.7 per cent of all patients admitted to the Clinical Center, National Institutes of Health, and approximately 1.8 per cent of patients admitted with hypercalcemia and malignant disease. The incidence of hypercalcemia and malignant melanoma is 1.1 per cent. Bone metastases are diagnosed before death in approximately 5.2 per cent of patients with malignant melanoma. The cause of hypercalcemia in our patients appears to be bone metastases in 83.3 per cent and primary hyperparathyroidism in 16.9 per cent.
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PMID:Hypercalcemia and malignant melanoma. 45 73

During 1976, inpatients with hypercalcaemia at The Royal Melbourne Hospital were identified from the worksheets of the Department of Biochemistry and compared with those discovered in a similar study in 1966. In 1966, the estimation of plasma calcium level had to be ordered specifically, whereas in 1976, for technical reasons, the measurement of plasma calcium level was frequently performed when not requested. Despite a six-fold increase in plasma calcium in the rate of detection of hypercalcaemia. In both studies, malignant disease was the most common casue of hypercalcaemia, but primary common cause of hypercalcaemia, but primary hyperparathyroidism was found slightly more frequently in 1976. This study suggests that screening inpatients for hypercalcaemia is of little value.
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PMID:Hypercalcaemia in adult hospital population: comparison of inpatients of 1966 with those of 1976. 45 98

A 17-year-old woman manifested fever, abdominal pain, headache, and hypertension caused by a solitary, benign pheochromocytoma. She also had hypercalcemia and elevated plasma immunoreactive calcitonin levels. After removal of the pheochromocytoma, calcium and calcitonin levels returned to normal. Studies of peripheral and tumor venous blood showed no excess or ectopic parathyroid hormone secretion, but the tumor contained and secreted calcitonin. Sporadic pheochromocytoma may secrete calcitonin and cause hypercalcemia by non-parathyroid hormone-mediated mechanisms. The potential is clearly present for confusion with multiple endocrine neoplasia, type 2 (medullary thyroid carcinoma, pheochromocytoma, and primary hyperparathyroidism).
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PMID:Pheochromocytoma associated with hypercalcemia and ectopic secretion of calcitonin. 46 64

The authors discusses some clinical, laboratory and instrumental problems of a reported case of primary hyperparathyroidism caused by adenoma from the point of view of medical literature. Nethertheless the lack of the specificity of the clinical manifestations and the slowly progressive evolution of this disease, primary hyperparatiroidism must be suspected in the presence of his most common multifarious complications. The finding of hypercalcemia in these conditions and from screening procedures requests parathyroid functional tests and exclusion of other causes of which chiefly pseudohyperparathyroidism may be difficult to be differentiated. The early diagnosis and correction of the parathyroid lesion avoid further damage and regression of many preoperatory complications.
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PMID:[A case of primary hyperparathyroidism. Clinical contribution]. 46 95

Malignant disease and primary hyperparathyroidism are the most common causes of hypercalcemia, but there are many minor causes. Mechanical or humoral factors, or both, may underlie the increase in bone resorption. Parathyroid hormone (PTH) is a major mediator of bone resorption, but many other humoral agents have the same effect, eg, prostaglandin, osteoclast-activating factor, and thyroid hormone. Serial determination of total calcium concentration is the most important laboratory test in hypercalcemia. Other useful tests include the determination of serum and urinary phosphorus concentration, chloride/phosphate ratio, urinary cyclic adenosine 3',5'-monophosphate (cAMP) level; carboxyl-terminal PTH assay; corticosteroid challenge; and appropriate radiologic studies. Nephrogenous cAMP and urinary prostaglandin determinations are research tools that hold great promise in the future. Differentiation between PTH- and non-PTH-mediated hypercalcemia determines subsequent steps in diagnosis and treatment.
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PMID:Differential diagnosis of hypercalcemia: a mechanistic approach. 48 78

A patient with primary hyperparathyroidism underwent cervical exploration and hemithyroidectomy. Only one normal parthyroid gland was found and was removed. Hypercalcemia persisted and subsequent arteriography localized a large mediastinal adenoma which was excised. Parathyroid autotransplantation of a small part of this tissue was performed and the patient was well for over a year. He again became markedly hypercalcemic and graft-dependent elevation of parathromone levels was demonstrated. Autograft resection resulted in normocalcemia. Nineteen months later hypercalcemia and elevated parathormone levels prompted re-exploration of the graft site and another enlarged implant was removed. This restored normocalcemia and normal parathromone levels. Parathyroid adenomatous tissue has the potential for autonomous hyperfunction, and caution must be exercised in its use in autotransplantation.
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PMID:Hyperparathyroidism following parathyroid autotransplantation. 49 61

Rapid differential diagnosis of hypercalcaemia due to primary hyperparathyroidism or malignancy with or without bone metastases may be life saving. A parathormone infusion test (6 USP units/kg body wt X 20 min) enables a differential diagnosis within three hours by means of measurement of renal calcium excretion. In normal persons calcium excretion decreased from 147 +/- 90 to 79 +/- 54 mumol/h (x +/- s, n = 10). In primary hyperparathyroidism with hypercalcaemia the high calcium excretion remained unchanged: 716 +/- 162 mumol/h before and 804 +/- 130 mumul/h 120 minutes after the PTH infusion (n = 12). In patients with hypercalcaemia caused by bronchial carcinoma with (n = 5) and without (n = 1) bone metastases calcium excretion decreased from 552 +/- 182 to 163 +/- 114 mumol/h. As a consequence of these data this test is advisable when the indication for operation in cases with hypercalcaemia has to be reached within a few hours.
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PMID:[Differential diagnosis of hypercalcaemia by measurement of renal calcium excretion during parathormone administration (author's transl)]. 49 90

Primary hyperparathyroidism is a major cause of calcium urolithiasis and is easily recognised when it is classically manifested. However, subtle presentations of primary hyperparathyroidism may cause confusion with other causes of calcium stone disease or cause diagnostic difficulty. Several pitfalls of parathyroid evaluation and treatment are illustrated by four cases of calcium urolithiasis. Cases 1 and 2 represent ineffective or useless parathyroid surgery rendered for renal hypercalciuria and absorptive hypercalciuria, respectively. Cases 3 and 4 had mild or intermittent hypercalcaemia. The correct diagnosis of primary hyperparathyroidism was made in Case 3 by parathyroid venous sampling and bone densitometry. In Case 4, the thiazide provocative test was used to establish the diagnosis of primary hyperparathyroidism.
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PMID:Pitfalls in parathyroid evaluation in patients with calcium urolithiasis. 50 80

Serum chloride and phosphate concentrations were measured in 79 hypercalcemic patients. The chloride values were higher (mean 106.7 mEq/l) and phosphate lower (mean 2.08 mg/100 ml) in the 53 hyperparathyroid patients, where as the chloride concentrations were lower (mean 99.3 mEq/l) and phosphate higher (mean 4.07 mg/100 ml) in the 26 patients with hypercalcemia from other causes. The chloride phosphate ratio ranged from 19 to 32 in the subjects with hypercalcemia from other causes with 90 per cent of values less than 30. In patients with primary hyperparathyroidism we found 96 per cent of the values more than 34. From our experience with chloride phosphate ratio it seems to us that this ratio is a very useful and simple preliminary test for distinguishing patients with primary hyperparathyroidism from patients with hypercalcemia from other causes, with normal renal functions.
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PMID:The chloride phosphate ratio as the screening test for primary hyperparathyroidism. 52 Oct 12


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