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

The bisphosphonates are the treatment of choice in hypercalcaemia of malignancy. However, plicamycin (mithramycin) an calcitonin treatment may still be of value should bisphophonate treatment fail, and gallium nitrate has recently been introduced as an alternative therapy. We analysed the tolerability of different treatments based on articles identified in a Medline search covering the period 1979 through September 1998. Articles were included if they met two criteria: (i) quantitative assessment of adverse effects; (ii) inclusion of > or = 10 patients. Although bisphosphonates are generally well tolerated, elevation of serum creatinine level, nausea/vomiting and fever have been reported following their application. Patients receiving etidronate (n = 268) or clodronate (n = 127) more frequently experienced creatinine elevation (8 and 5%, respectively) than did patients receiving pamidronate (n = 424; 2%), aledronate (n = 79; 0%), or ibandronate (n = 203; <1%). The difference in the frequency of reported creatinine level elevations reached statistical significance only for etidronate (z-test: p < 0.001 versus pamidronate; p < 0.02 versus alendronate; p < 0.001 versus ibandronate). With regard to the frequency of creatinine level elevations, clodronate treatment did not differ significantly from treatment with pamidronate, alendronate and ibandronate. An exception among the bisphosphonates is tiludronate, which has been reported on s a treatment of hypercalcaemia in only 1 study (n = 19) resulting in 1 case of lethal and 1 case of manageable acute renal failure. Nausea and vomiting are rare adverse effects of bisphosphonate treatment but seem to be more frequent with first generation drugs: etidronate (8%) and clodronate (7%) versus pamidronate (2%) [p < 0.001 and 0.009, respectively] and versus ibandronate (<1%) [p< 0.002 and 0.02, respectively]. Bisphosphonates containing a nitrogen atom were associated with an acute phase reaction leading to reported fever in 16% of pamidronate, 20% of aledronate, and 11% of ibandronate-treated patients. The most frequently reported adverse effects of treatment with the cytostatic drug plicamycin were hepatotoxicity (26%), nausea/vomiting (23%), and serum creatinine level elevation (5%). Furthermore. plicamycin application was associated with bone marrow suppression and a bleeding tendency due to abnormalities in multiple clotting factors and platelet dysfunction. The use of calcitonin is limited more by the short duration of its therapeutic effect than by toxicities (most frequent: nausea/vomiting in 16% of treated cases). The few publications on gallium nitrate in the treatment of hypercalcaemia of malignancy characterise it as an efficient drug, which is, however, associated with a higher frequency of renal toxicity (10%) and of nausea and vomiting (14%) than are the bisphosphonates.
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PMID:Comparative tolerability of drug therapies for hypercalcaemia of malignancy. 1055 53

Brown tumor is a focal lesion of the bone caused by primary or, less commonly, secondary or tertiary hyperparathyroidism (HPT). While the mandible is the most frequently involved bone in the head and neck region, atypical involvement of the cranium in the area of the sphenoid sinus is exceedingly rare. In the literature, a unique case of brown tumor of the sphenoid sinus was reported in a patient with primary HPT. We present a case of sphenoid sinus and occipital bone brown tumor associated with primary HPT. A 47-yr-old woman presented a 2-yr history of headaches, dizziness, diffuse body and articular pain, fatigue, and a 6-month history of intermittent nausea and vomiting, polydipsia, and polyuria. Magnetic resonance imaging (MRI) demonstrated an expansive mass lesion in the sphenoid sinus with erosion of the sellar floor and medial wall of the right orbit, and expansion in the medulla of bone. Examination of biopsy specimens obtained from sphenoid sinus mass confirmed the diagnosis of brown tumor. The biochemical laboratory studies showed elevation of parathyroid hormone and confirmed the diagnosis of primary HPT. Excision of a parathyroid adenoma affected the metabolic status into normalizing. At the follow-up of 12 months postoperatively, the size of sphenoid sinus brown tumor decreased and the mass of occipital bone disappeared. In conclusion, this is a first report of primary HPT masquerading as a destructive fibrous sphenoid sinus brown tumor associated with a mass lesion of occipital bone and hypercalcemia in the literature.
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PMID:Sphenoid sinus brown tumor, a mass lesion of occipital bone and hypercalcemia: an unusual presentation of primary hyperparathyroidism. 1523 58

Secondary hyperparathyroidism (SHPT) is associated with parathyroid gland hyperplasia, increased parathyroid hormone (PTH) production and secretion, disturbed bone and mineral metabolism, soft tissue calcification and an increased risk of death. The condition is an almost universal complication of end-stage renal disease (ESRD) and currently is managed by treatment with phosphate binders and vitamin D compounds, both of which are associated with significant side effects, including hypercalcaemia and hyperphosphataemia. Therapy with calcimimetics is a new approach to the treatment of SHPT. These agents act at the calcium-sensing receptor (CaR), where they increase the sensitivity of the receptor to ionized serum calcium. Activation of the CaR results in a rapid reduction in PTH secretion. The calcimimetic drug cinacalcet HCl currently is undergoing clinical trials in dialysis patients who have uncontrolled SHPT, despite treatment with vitamin D compounds and/or phosphate binders. Clinical trials have confirmed that the drug rapidly reduces plasma PTH, phosphorus and calcium-phosphorus product (Ca x P) levels, and that levels of PTH, phosphorus and Ca x P remain suppressed for up to 3 years. In clinical trials, cinacalcet HCl was a well-tolerated drug; only nausea and vomiting occurred more frequently in patients who took cinacalcet HCl than in those who took placebo, and the occurrence of transient hypocalcaemia was limited to the initial phase of the treatment. Cinacalcet HCl is therefore a potentially highly effective and well-tolerated treatment for SHPT in patients with ESRD.
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PMID:Clinical experience with cinacalcet HCl. 1528 57

Primary hyperparathyroidism is a hypercalcemic condition generated as a result of overproduction of parathyroid hormone (PTH) by one or more of the parathyroid glands. The cause is usually an abnormal group of cells forming a benign adenoma and rarely carcinoma. The condition is usually discovered by routine serum chemistry analysis showing hypercalcemia, hypophosphatemia, and elevated PTH levels. Elevated 24-hour urine calcium provides further confirmation. During the last decade, three procedures have been developed to help diagnose the affected parathyroid gland(s) in preparation for surgical intervention: computerized nuclear scanning with technetium-99-m sestamibi performed preoperatively; radio-guided probes; and rapid PTH assay (RPHA), both used intraoperatively. These three techniques have been reported to reduce the need for immediate frozen section diagnosis; shorten the length of the incision, surgical time, and length of hospital stay; produce less pain and discomfort; reduce surgical cost; and produce a quicker return to normal life. This article follows the surgical experience of a patient with a diagnosis of hyperparathyroidism and a history of postoperative nausea and vomiting who was scheduled as 23-hour stay.
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PMID:Primary hyperparathyroidism: a case study. 1547 82

A 18-year old patient presents abdominal pains associated with nausea and vomiting six weeks after a multiple trauma leading to paraplegia. Esophagitis, urolithiasis, and acalculous cholecystitis were diagnosed. This report illustrates two rare abdominal complications of a multiple trauma with immobilisation: acalculous cholecystitis, hypercalcaemia, coralliform urolithiasis following urinary infection and bacteriurie with Enterobacter Cloacae. The interpretation of the abdominal semiology of a multiple trauma's patient presenting long-term immobilization may be misleading.
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PMID:[When a multiple trauma complains about abdominal pains six weeks after the fall. . ]. 1742 79

Nausea and vomiting are frequent symptoms that deteriorate the quality of life of lung cancer patients. They are most often iatrogenic and related to chemotherapy based on platinum salts; they can also be evidence of metastasis to the brain or hypercalcemia. Understanding the physiopathological mechanisms at work can make it possible to adopt effective therapeutic measures that are specific to each etiological context.
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PMID:[Managing nausea and vomiting in thoracic oncology]. 1858 87

We encountered a 58-year-old female patient who developed hypercalcemia and multiple bone lesions. She complained of lumbodorsal pain, nausea and vomiting on admission. Radiographic examination revealed multiple osteolytic lesions. She was diagnosed diffuse large B cell lymphoma (BLBCL) by bone marrow examination and biopsy of cervical lymph node. She underwent eight cycles of chemotherapy and is now in the stable stage. Osteogenic potential of mesenchymal stem cells from bone marrow was found to be correlated with the expression of Dickkopf1 (DKK-1) in the bone marrow plasma and lymphoma cells before and after treatment. PTH-related protein (PTHrP) expression was detectable in the lymphoma cells and was elevated in the serum. The receptor activator of nuclear factor kappaB ligand expression was found to be elevated in the bone marrow plasma and mesenchymal stem cells. These findings suggest that factors affecting the differentiation of both osteoblasts and osteoclasts involved in the pathogenesis of hypercalcemia and bone lesions of lymphoma. This was similar to that of multiple myeloma in which bone lesions and hypercalcemia are frequently observed.
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PMID:Multiple bone lesions and hypercalcemia presented in diffuse large B cell lymphoma: mimicking multiple myeloma? 2037 6

Primary hyperparathyroidism (PHPT) is not an uncommon endocrine disorder. However, acute primary hyperparathyroidism, or parathyroid crisis (PC), is a rare clinical entity characterized by life-threatening hypercalcemia of a sudden onset in patients with PHPT. We describe a patient with PC who presented with acute worsening of depressive symptoms, nausea and vomiting, and required emergency surgery. Serum calcium, alkaline phosphatase, and parathyroid hormone were elevated and serum phosphorus was low. An emergency hemithyroidectomy was performed because of none medical control of hypercalcemia. A giant intrathyroidal parathyroid adenoma was diagnosed. PHTP can be a life-threatening situation for patients, requiring immediate surgical treatment. A giant intrathyroidal parathyroid adenoma is an uncommon cause of PC.
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PMID:Giant intrathyroidal parathyroid adenoma. 2278 55

A 67-year-old woman was admitted to the hospital due to progressive mental changes, nausea and vomiting after a dose increase of an intrathecal morphine pump. We found severe hypercalcaemia due to milk alkali syndrome (MAS). Her symptoms resolved quickly after normalisation of hypercalcaemia. Similar to the original and the modern versions of the syndrome, ingested carbonate was the main source of bicarbonate in our case. The main trigger was a morphine overdose with volume contraction due to vomiting and a further aggravation of chronic compensatory elevation of bicarbonate due to hypoventilation leading to MAS; thus, suggesting hypoventilation as a risk factor for MAS.
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PMID:Hypoventilation: a risk factor for milk alkali syndrome? 2279 90

This case report describes a pregnant woman with severe primary hyperparathyroidism. The symptoms, mainly nausea and vomiting, were not recognized as symptoms of hypercalcaemia, but ascribed to the pregnancy. As she was diagnosed, parathyroidectomy was performed and the symptoms ceased. Primary hyperparathyroidism in pregnancy can among other things cause pregnancy loss, intrauterine growth retardation and neonatal tetanus caused by hypocalcaemia. The case demonstrates the need for measuring serum calcium in pregnant women with severe hyper emesis and a record of unexplained miscarriages.
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PMID:[Primary hyperparathyroidism can be mistaken as pregnancy inconvenience]. 2303 4


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