Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0151825 (bone pain)
 3,118 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Tumor-induced hypercalcemia and tumor-induced osteolysis are essentially due to a marked increase in osteoclast-mediated bone resorption, although the kidneys play an important contributory role in the genesis of tumor-induced hypercalcemia. Parathyroid hormone-like protein plays an essential role in tumor-induced hypercalcemia, and maybe in tumor-induced osteolysis, but other factors could also be responsible for the osteoclast activation secondary to the neoplastic infiltration of the skeleton. Treatment of tumor-induced hypercalcemia essentially consists of volume repletion and administration of potent anti-osteolytic drugs. The bisphosphonate pamidronate is particularly useful for that matter and a dose of 1.0 to 1.5 mg/kg can normalize serum calcium in about 90% of hypercalcemic cancer patients. The apparently low response rate of bone metastases to systemic antineoplastic therapy seems to essentially reflect the relative insensitivity of our current methods for assessing response in tumor-induced osteolysis. Newly developed biochemical markers of bone turnover could be particularly useful for that matter. Bisphosphonates are the most potent of the available inhibitors of osteoclast activity. Prolonged administration of oral pamidronate could reduce by almost one half the complications of tumor-induced osteolysis, and repeated bisphosphonate infusions could induce a dramatic relief of bone pain in one third and a sclerosis of lytic lesions in one fourth of the cases. These data must, however, be confirmed in randomized, blinded trials and many questions remain unanswered concerning the optimal therapeutic schemes. Medical therapy of tumor-induced osteolysis by noncytotoxic means has nevertheless become a reality.
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PMID:Bone metastases and tumor-induced hypercalcemia. 151 Oct 19

Hyperparathyroidism and its related symptoms such as bone pain, soft-tissue calcifications and pruritus often get worse during dialysis treatment. We have treated 12 cases among 170 patients on regular dialysis by using coated charcoal (150 g/cartridge) in combination with standard hemodialysis. During a 6-month treatment period, without changing medical therapy and diet regime, the patients reported a marked relief from pruritus. Parathyroid hormone (PTH) levels changed from 552 +/- 86 to 364 +/- 62 pg/ml (p less than 0.001) compared to the pretreatment period, Plasma PO4(3-) changed in the same period from 6.9 +/- 1.8 to 4.6 +/- 1.5 mg/dl (p less than 0.005). The results obtained indicate a relationship between PTH, serum plasma PO4(3-) levels and pruritus. The mechanism which may be involved is that hemoperfusion removes PTH excess by absorption. Our treatment reducing PTH levels resulted in a marked relief from pruritus and other symptoms, suggesting that patients in this condition, before undergoing surgical parathyroidectomy, may be usefully treated with this therapeutic modality.
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PMID:Combined hemodialysis-hemoperfusion in the treatment of secondary hyperparathyroidism of uremic patients. 180 57

Hypophosphataemic osteomalacia occurred in a 38-year-old woman. The leading clinical symptom was severe bone pain. X-ray studies demonstrated fractures of the iliac crest and pubic and ischiadic bone, as well as Looser's zones and demineralization of the skeleton. Computerized densitometry of the bone revealed a 31% reduction of hydroxyapatite. Histological evaluation showed nearly absence of osteoclasts and extensive demineralisation of the bone. Hypophosphataemia (0.48 mmol/l), increased urinary phosphate clearance (36 ml/min), reduced renal-tubular reabsorption for phosphate (73%) and increased alkaline phosphatase (355 U/l) were present. Parathyroid hormone and 1,25-dihydroxyvitamin D were normal. No inborn errors, disturbances of the calcium metabolism or paraneoplastic signs could be detected. Defective renal tubular reabsorption of phosphate is likely to be the underlying cause of the disease. Phosphate supplementation and intermittent vitamin D administration remains the therapy of choice.
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PMID:[Hypophosphatemic osteomalacia in adults]. 270 31

During the period from December 1984 to December 1986, ten patients with end-stage renal disease were evaluated with hyperparathyroidism refractory to medical management. Symptoms were bone pain in eight patients and pruritus and constipation in two. Two patients with bone pain also had impaired mentation. Biochemical preoperative assessment revealed calcium levels between 8.7 and 11.2 milligrams per deciliter, with a median of 10.5 milligrams per deciliter. Phosphate levels were normal in all but three patients, and the phosphate-calcium product was greater than 80 in two. Parathyroid hormone levels assessed with the radioimmunoassay method were elevated in all patients, and results of ultrasound of the neck, done in seven patients, revealed hyperplastic glands in six patients and normal glands in one patient. All patients underwent surgical exploration of the neck with removal of four parathyroid glands and immediate autotransplantation. No complications related to the operative procedure occurred. Postoperative calcium levels ranged between 6.5 and 9.5 milligrams per deciliter on the first postoperative day and normalized by the sixth day. Four patients experienced symptomatic hypocalcemia requiring intravenous calcium supplementation for one to six days postoperatively. The mean hospital stay was four days (three to seven days). All patients had histologically confirmed four gland parathyroid hyperplasia. Marked improvement of symptoms was accomplished in all patients after a period of three to 30 days. One patient required revision of the forearm parathyroid transplant after four months. One patient required calcium supplementation taken orally, two patients required 1,25-Dihydroxyvitamin D3 and five required treatment with both. Two patients did not require any further medical treatment, and no patient had recurrent symptoms after a mean follow-up period of eight months. We recommend total parathyroidectomy with autotransplantation in patients with end-stage renal disease as a safe and effective procedure for symptomatic refractory hyperparathyroidism. Symptom relief can be accomplished in the vast majority of patients.
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PMID:Surgical treatment of the parathyroid gland in patients with end-stage renal disease. 338 Nov 85