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)

We report the case of a 63-year-old man who presented with weakness, fatigue, dehydration, confusion, abdominal pain, congestive heart failure and hypercalcemia. He expired and autopsy revealed an exulcerating carcinoma of the esophagus, invading the esophageal wall and metastasizing to the lungs, skin and lymph nodes. Histology demonstrated an epithelial tumor consisting of two components with transition between the two. One component was a keratinizing squamous cell carcinoma, whereas the other component consisted of pleomorphic small cells. The hypercalcemia was assumed to be due to parathyroid hormone related protein (PHRP), which was demonstrated by immunohistochemistry only in the pleomorphic small cells and not in the squamous cells. PHRP induced humoral hypercalcemia of malignancy is most often associated with squamous cell carcinomas. The finding that in our case, the pleomorphic small cell component was PHRP immunopositive and the squamous cell component showed no immunoreactivity, is intriguing and remains unexplained.
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PMID:Humoral hypercalcemia of malignancy due to bipartite squamous cell/small cell carcinoma of the esophagus immunoreactive for parathyroid hormone related protein. 1464

Eleven cases of tuberculous peritonitis (TBP) in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients at the Kaohsiung Veterans General Hospital in Kaohsiung, Taiwan between 1991 and 2000 were studied retrospectively (six cases in the HD group and five cases in the CAPD group) The diagnosis of TBP was established by either positive ascite tuberculosis (TB) culture or biopsy-proven chronic granulomatous inflammation. Fever and abdominal pain were the most common symptoms, while leukocytosis and unexplained hypercalcemia were the most common laboratory findings. Ascite analysis showed a lymphocyte predominance in all HD patients, but in only 40% of the CAPD patients. The mean duration of a diagnosis by ascite TB cultures was six weeks, while a diagnosis confirmed by laparascopic biopsy took one week. All four fatal cases were diagnosed by TB cultures. Laparoscopic biopsy provided a rapid diagnosis and resulted in low morbidity and mortality in our patients. Based on our review of all possible abstracts found in a Medline search from 1966 to 2002 using the keywords tuberculosis, peritonitis, uremia, and dialysis, this may be the first study of TBP in different dialysis patients.
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PMID:Tuberculous peritonitis in different dialysis patients in Southern Taiwan. 1515 86

Sarcoidosis is a granulomatous, multisystem disease. Rarely, sarcoidosis may present with both renal failure and hypercalcemia. A 27-year-old black man presented with severe abdominal pain and renal failure. A kidney biopsy demonstrated features of both interstitial nephritis and membranous glomerulopathy thought to be secondary to nonsteroidal anti-inflammatory drugs. His renal function and symptoms improved with short-term prednisone therapy. Discontinuation of steroids led to a recurrence of renal failure and severe hypercalcemia. On the basis of an elevated angiotensin-converting enzyme level of 160 U/L and anemia, a bone marrow biopsy was performed. Acid-fast bacillus-negative, noncaseating granulomas suggested the diagnosis of sarcoidosis. The patient recovered after restarting prednisone. Sarcoidosis may cause both interstitial and membranous nephritis from direct infiltration. Hypercalcemia results from increased calcium absorption secondary to 1,25-dihydroxyvitamin D production by sarcoid granulomas. Sarcoidosis must be considered in the differential diagnosis of renal failure in black patients. Serum calcium and angiotensin-converting enzyme levels may aid the diagnosis.
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PMID:Renal failure and hypercalcemia as initial manifestations of extrapulmonary sarcoidosis. 1525 28

Hypercalcemia is a well-known manifestation of paraneoplastic syndromes associated with a variety of malignancies. However, colon cancer has only rarely been associated with hypercalcemia. Here we present the first case of adenosquamous carcinoma of the sigmoid colon in a patient who was found to have hypercalcemia associated with parathyroid hormone-related protein (PTHrP), with no radiological evidence of metastasis to other organs. A 78-year-old woman was admitted to our hospital complaining of lower abdominal pain. Physical examination and computed tomography revealed a tumor, 13 cm in diameter, in the sigmoid colon. Laboratory data showed an elevated serum calcium level (11.2 mg/dl). Primary colostomy was performed. After the primary operation, the patient was found to have hypercalcemia and an elevated PTHrP level. We performed sigmoidectomy, total hysterectomy, and partial urinary bladder resection 1 month after the primary operation, and both PTHrP and calcium levels immediately returned to normal. The histopathologic diagnosis was poorly differentiated adenosquamous carcinoma. The patient died due to tumor recurrence 4 months after the second surgery.
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PMID:Paraneoplastic hypercalcemia with adenosquamous carcinoma of the colon. 1586 2

We describe a patient who presented with abdominal pain radiating to the chest and ST elevation in the precordial leads, mimicking acute myocardial infarction. Urgent coronary angiography revealed normal coronary arteries and his serum troponin has not increased. Subsequently, he was found to have severe hypercalcemia. ST segment elevation resolved after correction of hypercalcemia. This phenomenon of ST elevation secondary to hypercalcemia has been described only two times in the English literature to date.
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PMID:Hypercalcemia-induced ST-segment elevation mimicking acute myocardial infarction. 1702 38

Hypocalcaemia not associated with hypoalbuminaemia or 25(OH)-Vitamin D deficiency is rare and should be referred to a specialist clinic. 25(OH)-Vitamin D deficiency can often be treated safely by GPs, unless it is associated with renal impairment and secondary hyperparathyroidism, in which case a nephrology referral is required. An endocrine referral is required if deficiency is associated with pregnancy, co-existent primary hyperparathyroidism or the patient is receiving warfarin. The key role of the GP in managing hypercalcaemia is to distinguish between malignant and parathyroid causes in order to make the appropriate specialist referral (oncology, endocrine or renal). Severe hypercalcaemia (greater than 3.5 mmol/L or hypercalcaemia with dehydration, abdominal pain or reduced consciousness is a medical emergency.
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PMID:Disorders of calcium metabolism. 1703 12

We report a case of radioguided parathyroidectomy in a patient with parathyroid carcinoma. A 61-year-old woman presented to our center with persistent hypercalcemia (17.2 mg/dL) and hyperparathyroidism (PTH=324 pg/mL) following her second neck resection for recurrent parathyroid carcinoma at an outside facility. Her elevated serum calcium had not responded to treatment with intravenous bisphosphonates, furosemide, or calcitonin. Calcimemetic therapy (Cinacalcet) was effective but had to be discontinued due to GI intolerance. She requested a second opinion at our center after being referred for palliative radiation therapy for presumed inoperable disease. On presentation, she remained symptomatic with bone and joint pain, diffuse abdominal pain and fatigue. Repeat technetium-99m sestamibi (Tc-99m sestamibi) scintigraphy showed a faint area of uptake near the right clavicular head, adjacent to the site of her previous resections. With the intraoperative guidance of a hand-held gamma probe, a 2 cm recurrent parathyroid carcinoma was located and successfully excised. Intraoperative PTH levels confirmed surgical cure of this previously undetected foci of disease. The use of radioguidance and intraoperative PTH monitoring were the keys to a successful resection, and our patient remains disease free with 17 months of follow-up.
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PMID:Radioguided parathyroidectomy for recurrent parathyroid cancer. 1745 61

Primary hyperparathyroidism (PHPT) is classically thought of as the somatic manifestation of hypercalcemia in which patients suffer from a variety of complaints including abdominal pain, nephrolithiasis, osteopenia, and mental status changes. Contemporary PHPT patients are generally free of somatic manifestations and are most often diagnosed when routine biochemical testing shows an elevated serum calcium level. The modern day patient may present with much more subtle neurocognitive symptoms including fatigue, lethargy, muscle weakness, depression, and cognitive impairment. Advances in imaging technology, intraoperative parathyroid hormone measurement, and surgical technique now allow parathyroidectomy to be performed using a focused approach without the absolute need of a four-gland exploration. Minimally invasive techniques allow the procedure to be accomplished under local anesthesia on an outpatient basis. This brief review summarizes the presentation, biochemical evaluation, operative intervention, and follow-up care of the modern day PHPT patient.
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PMID:Primary hyperparathyroidism. 1760 56

A 60-year-old woman was diagnosed with esophageal small cell carcinoma in October 2004 and received chemotherapy. However, the tumor grew gradually and multiple bone metastases occurred. Anorexia, nausea, emesis, numbness in both hands, and disturbed consciousness developed at the end of January 2006, and the patient was admitted to Fukushima Medical University Hospital. Abdominal pain, marked hypercalcemia and hyperamylasemia were noted and the patient was diagnosed with severe acute pancreatitis. Because the level of blood parathyroid hormone-related protein was elevated, we considered that esophageal small cell carcinoma caused human hypercalcemia of malignancy and that metastatic bone tumors caused local osteolytic hypercalcemia, eventually leading to severe acute pancreatitis. This is an extremely rare case of esophageal small cell carcinoma associated with hypercalcemia causing severe acute pancreatitis.
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PMID:A case of esophageal small cell carcinoma associated with hypercalcemia causing severe acute pancreatitis. 1795 66

Hypercalcemia is an uncommon cause of abdominal pain and may be overlooked in the Emergency Department. In this case report, we describe the case of a 48-year-old woman with a prior history of urolithiasis who presented to the Emergency Department with diffuse abdominal pain. She had taken Trichlormethiazide 1 mg daily for her urolithiasis. She was diagnosed with thiazide-related hypercalcemia; hyperparathyroidism and thyroid papillary carcinoma were unveiled during her hospitalization. A thorough history and complete physical examination, paired with appropriate but judicious diagnostic testing, are essential to detecting these unusual causes of abdominal pain.
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PMID:An unusual cause of abdominal pain: thiazide-related hypercalcemia in a patient with veiled hyperparathyroidism and thyroid papillary carcinoma. 1802 79


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