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

Parathyroid carcinoma accounts for 0.5 to 5% of all cases of hyperparathyroidism. We reviewed the clinical, surgical, and pathologic features observed in all patients with parathyroid carcinoma evaluated at the Mayo Clinic from 1920 through 1991. Forty-three patients (22 women, 21 men; mean age, 54 yrs, range 29-72) were identified, including 2 with familial hyperparathyroidism. Information on initial presentation was available in 40 patients: 15 (38%) presented with polydipsia or polyuria, 11 (27%) with myalgias or arthralgias, 7 (17%) with weight loss, and 4 (10%) with nephrolithiasis; 3 patients (7%) were asymptomatic at presentation. Of 31 patients in whom the initial neck examination was recorded, 14 (45%) had a palpable neck mass. The mean serum calcium and serum phosphorus levels were 14.6 mg/dl and 2.3 mg/dl, respectively. Parathyroid hormone levels were elevated in 21 of 21 patients (mean elevation, 10.2 times upper limit of normal). Complications included nephrolithiasis in 14 of 25 patients (56%), bone disease in 20 of 22 patients (91%) and both in 8 of 15 patients (53%). All patients underwent primary surgical resection of parathyroid carcinoma. Twenty-six of 43 patients (60%) required a second operation with 18 patients requiring multiple re-explorations. At the second operation, residual tumor was found in the neck (68%), mediastinum (16%), or both (12%). Six patients received radiation therapy to the neck (5 patients) or bones (1 patient) for recurrent or metastatic disease. Of these, 1 patient appeared cured of parathyroid carcinoma by radiation therapy 11 years after documented tumor invasion of his trachea. Repeated excision of tumor recurrences was an effective means of controlling hypercalcemia in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Parathyroid carcinoma: clinical and pathologic features in 43 patients. 151 93

A retrospective review of 25 patients who underwent orthotopic liver transplantation was performed to relate the prevalence and preferred sites of microscopic calcium deposition seen at autopsy to clinical parameters, namely, hypercalcemia, hypercalcemia, hyperphosphatemia, and renal failure. Microscopic foci of calcification were noted in 84% of patients, and hypercalcemia was noted in 68%. Multiple regression analysis demonstrated that the number of microscopically calcified organs depended in part on the peak total serum calcium level and the duration of hypercalcemia and that the peak total serum calcium level depended in part on the peak phosphorus level and the quantity of calcium administered intraoperatively. Univariate analysis showed that peak phosphorus level was partially dependent on the peak creatinine level. The data suggest that hypercalcemia and postoperative ectopic calcification are common and related occurrences following hepatic transplantation and that intraoperative manipulations of serum calcium levels and renal failure partially, but not entirely, account for this phenomenon.
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PMID:Tissue calcification after orthotopic liver transplantation. An autopsy study. 152 56

Inadequate low intake of phosphorus can induce a hypophosphatemic depletion syndrome resulting in hypercalcemia, hypercalciuria, hypophosphatemia, and rickets. Tubular reabsorption for phosphate per liter glomerular filtration rate (TP/GFR) has been proposed as a reliable index of renal phosphate handling for all age groups. In the present study, carried out in 12 healthy premature babies fed unmodified pooled human milk and then a preterm formula for two periods of 10 days, we demonstrated clearly that TP/GFR as well as calciuria can reflect the poor phosphorus intake and that the kidney of preterm babies is able to rapidly adapt itself to an increase in phosphorus diet content.
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PMID:Phosphorus intake in preterm babies and variation of tubular reabsorption for phosphate per liter glomerular filtrate. 152 68

Control of phosphorus accumulation in chronic renal insufficiency is crucial to the prevention of secondary hyperparathyroidism and metastatic calcification. In early renal failure, calcitriol levels are normal and parathyroid hormone levels are elevated. The phosphorus levels are maintained in the normal range by the phosphaturia induced by hyperparathyroidism. In this situation, dietary phosphorus restriction increases calcitriol levels and suppresses parathyroid hormone secretion. As renal failure progresses into late stages, hyperphosphatemia is evident along with low levels of calcitriol and worsening hyperparathyroidism. Phosphorus restriction will not affect calcitriol concentrations, yet parathyroid levels may decline. During long-term dialysis, urinary excretion of phosphorus is usually minimal. Therefore, phosphorus balance is determined primarily by the net amount absorbed by the bowel and the quantity removed during dialytic therapy. Given an adequate diet, no form of conventional dialysis is able to fully compensate for the gastrointestinal absorption of phosphorus. Hence, compounds that bind phosphorus in the bowel are often necessary. With the realization that the use of phosphorus binders containing aluminum leads to aluminum accumulation and its sequelae: osteomalacia, dementia, myopathy, and anemia, other phosphorus binders have been evaluated. Calcium carbonate has been investigated the most thoroughly and is in wide use. It is inexpensive and contains a high percent of elemental calcium. However, it is only modestly potent in the binding of phosphorus, and large doses are often necessary to attain satisfactory control of phosphorus. This may lead to hypercalcemia. One approach to this problem is to decrease the concentration of calcium in the dialysate. Alternatively, a more effective phosphorus binder may be used. Calcium acetate has been shown in acute studies to have twice the binding capacity of phosphorus per calcium absorbed than calcium carbonate. Whether use of this compound decreases the incidence of hypercalcemia is unproven. Calcium citrate increases the gastrointestinal absorption of aluminum and offers no advantage over calcium carbonate. Other compounds, such as calcium ketoacids and calcium alginate, have not been extensively studied and are not generally available. The use of phosphorus binders containing magnesium in conjunction with a dialysate low in magnesium may be efficacious. Large doses of magnesium will cause diarrhea and thus limit its use as a single agent. Reasons for failure to control hyperphosphatemia include poor compliance, improper prescription of binders, poor dissolution rates seen with some generic brands of calcium carbonate, and the presence of severe hyperparathyroidism. Optimal control of serum phosphorus in dialysis patients should always be viewed in the context of adequate nutrition and protein intake.
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PMID:Hyperphosphatemia: its consequences and treatment in patients with chronic renal disease. 156 18

Embryonic chickens were exposed to 0, 30, or 300 pg of calcitriol per day via slow-release pellets implanted adjacent to the chorioallantoic membrane. Pellets were placed in eggs on Days 10 and 15, and eggs were sampled on Days 12 and 17, respectively. The hormone induced high mortality among embryos receiving pellets on Day 10, but not among those whose treatment was begun on Day 15. Embryos receiving hormone were hypercalcemic and hypophosphatemic on both Day 12 and Day 17, but the concentration of magnesium in plasma was not affected. Size of embryos sampled on Day 12 was not affected by hormone treatment, but embryos sampled on Day 17 showed a dose-related reduction in size. Yolk-free carcasses of the embryos sampled on Day 17 also showed dose-dependent reductions in phosphorus and magnesium, but calcium content of carcasses on Day 17 was unaffected by treatment. These results indicate that both younger and older embryos respond to very small quantities of calcitriol administered via slow-release pellets. The absence of sustained hypercalcemia in earlier studies that used this protocol to dispense hormone was not caused by exposing older embryos to subthreshold quantities of calcitriol. The fact that reduced body size in late embryos receiving calcitriol was not accompanied by a reduction also in calcium content may mean that embryos deposit calcium in the carcass in an effort to deal with the extreme hypercalcemia induced by calcitriol.
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PMID:Variation during development in the response of chicken embryos to calcitriol administered via slow-release pellets. 156 15

The effect of synthetic human parathyroid hormone-related peptide fragment 1-34 (hPTHrP) on plasma concentration and urinary excretion of inorganic phosphorus (P) was compared to that of synthetic bovine PTH fragment 1-34 (bPTH) in four 120- to 130-day-old fetal lambs chronically catheterized in utero. They received by I.V. infusion according to a Latin square design either bPTH (6 nmol per fetus) or hPTHrp (6 nmol per fetus) alone, or after the synthetic analogue [Tyr34]bPTH(7-34)NH2 (12 nmol per fetus). Control fetuses received the same volume of solvent alone. Both bPTH and hPTHrP stimulated diuresis. They induced hypercalcaemia, hyperphosphaturia and hypophosphataemia. The effects of hPTHrP were inhibited by [Tyr34]bPTH(7-34)NH2, indicating that PTHrP might work through the PTH receptor.
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PMID:Parathyroid hormone-related peptide increases urinary phosphate excretion in fetal lambs. 158 Oct 66

We report on a 7-week-old infant with idiopathic hypercalcemia, hypercalciuria and nephrocalcinosis. At the time of admission, serum concentrations of parathyroid hormone and 1,25(OH)2D3 were found to be inadequately high, and those of calcitonin and 24,25(OH)2D3 too low, relative to the hypercalcemia. Treatment with calcitonin normalized serum calcium concentrations within 4 days, and a 3-week course of thiazides combined with a decreased dietary calcium:phosphorus ratio corrected the hypercalciuria. A repeat profile of the calcium-regulating hormones done at the age of 5.5 months was normal. Based on the clinical course and the hormonal profiles, we hypothesize that the idiopathic infantile hypercalcemia in this patient could have resulted from a generalized maturational delay of calcium homeostasis. Treatment with calcitonin, therefore, seems to be the most appropriate way to control the hypercalcemia.
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PMID:Idiopathic infantile hypercalcemia: rapid response to treatment with calcitonin. 160 83

Six cases of acute renal failure (ARF) due to rhabdomyolysis were experienced between 1984 and 1989. Patients' ages ranged from 33 to 92 years old (average ages 61) and all were male. The causes of rhabdomyolysis were as follows: one crush syndrome, one acute arterial occlusion, one diabetic hyperosmolar nonketotic coma and three cases of malignant syndrome due to neuroleptica (mainly haloperidol). Underlying diseases included, one case of abdominal aneurysm, two cases of diabetes mellitus, two cases of schizophrenia and one case of reactive psychosis. Dehydration was considered as an important factor in the onset of rhabdomyolysis and ARF, because it was observed in 4 of the cases in this study. In all cases, the serum levels of potassium, phosphorus and uric acid as well as myoglobin and myogenic enzymes increased markedly. In patients with myoglobinuric ARF, severe metabolic acidosis and hypocalcemia in the oliguric phase and hypercalcemia in the diuretic phase were prominent. Muscle biopsy showed myolytic degeneration in 2 of 4 cases. Five cases were treated with hemodialysis and one case was managed conservatively. All 6 cases had relatively good prognosis. However, 3 cases with malignant syndrome showed outcomes more severe than in the other 3 cases without such syndrome.
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PMID:[Acute renal failure due to rhabdomyolysis--clinical investigation on our 6 cases]. 163 34

Some cereal by-products, such as bran, exhibit a high phytase activity that may enhance phytate P digestibility. This was studied in growing pigs fed a phytase-rich (1,200 IU/kg) diet containing 20% rye bran. The trial involved 12 animals; six were fed a control diet and six were fed a diet containing rye bran for 2 mo. Both diets contained the same levels of energy, protein, Ca (.7%) and total P (.4%). No inorganic P was added; thus, the dietary P was mainly phytic. Pigs fed the control diet, in contrast to those fed the diet containing rye bran, developed a P deficiency, as indicated by hypophosphatemia, hypophosphaturia, hyperhydroxyprolinuria, hypercalcemia, and hypercalciuria. Phosphorus from the rye bran diet was more completely absorbed (55 vs 36%) and retained (50 vs 36%) than that from the control diet. Calcium absorption was equal for the two diets, but Ca retention was higher in pigs fed rye bran than in controls. Pigs fed the rye bran diet showed greater bone density, ash content, and bending moments than controls. In conclusion, high dietary phytase levels or phytase-rich by-products increased phytate P availability and consequently improved bone scores.
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PMID:Enhancement of phosphorus utilization in growing pigs fed phytate-rich diets by using rye bran. 164 62

Male broiler chicks (1-d-old; Ross one) were given either a control diet containing recommended levels of phosphorus, calcium and cholecalciferol or experimental diets low in P and with variable levels of Ca (normal and low) and cholecalciferol (normal or high). The low-P diet with normal levels of Ca and cholecalciferol induced a hypophosphataemia and a hypercalcaemia which was reflected in reduced tibia length and weight and in reduced Ca, P and magnesium contents of tibia. The phytate digestibility remained normal while the retention of P and Ca fell significantly. The lowering of Ca alone elevated phytate digestibility and restored P and Ca retention. The hypercalcaemia and hypophosphataemia remained and tibia mineralization remained impaired. The raising of cholecalciferol alone dramatically increased phytate digestibility and the retention of Ca and P. While this remedied the hypercalcaemia, the hypophosphataemia persisted as did the diminution of tibia weight. The simultaneous lowering of dietary Ca and elevation of cholecalciferol on low-P diets restored all variables to the levels for the control diet. Circulating levels of 1,25-dihydroxycholecalciferol were significantly elevated by low-P diets, more so with high cholecalciferol intakes. However, Ca did not influence 1,25-dihydroxycholecalciferol levels in plasma.
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PMID:The effects of dietary levels of inorganic phosphorus, calcium and cholecalciferol on the digestibility of phytate-P by the chick. 166 69


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