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Sukhija T, Midha V, Mittal N, Kalra E, Chouhan K, Singh D, Dishant F, Attri P, Goyal MK, Arora S. Clinical Profile and Outcomes of Patients With Hypercalcemia in an Indian Tertiary Care Center. Cureus 2023; 15:e46062. [PMID: 37900460 PMCID: PMC10606792 DOI: 10.7759/cureus.46062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Hypercalcemia is a complex medical condition characterized by elevated levels of serum calcium (>10.5 mg/dL) in the bloodstream, often arising from various underlying etiologies. This condition presents a significant clinical challenge due to its diverse clinical manifestations and potential for serious complications. Profiling and understanding hypercalcemia is essential for accurate diagnosis, appropriate management, and improved patient outcomes. In this study, we delve into the comprehensive profiling of hypercalcemia, encompassing its epidemiology, pathophysiology, clinical presentation, and diagnostic approaches. We explore the multifaceted etiological factors contributing to hypercalcemia, including primary hyperparathyroidism, malignancies, granulomatous disorders, medications, and more. We highlight the intricate interplay between parathyroid hormone, vitamin D, and other regulatory mechanisms that influence calcium homeostasis, shedding light on the underlying molecular pathways. Furthermore, we discuss the diverse clinical manifestations of hypercalcemia, ranging from asymptomatic cases to severe, life-threatening complications involving the renal, gastrointestinal, cardiovascular, and neuromuscular systems. Accurate diagnosis is pivotal, and we evaluate the array of laboratory tests, imaging modalities, and specialized assays that aid in identifying the root cause of hypercalcemia. We emphasize the importance of a systematic approach to differential diagnosis and the significance of risk stratification to guide clinical decision-making. The evolving landscape of treatment options for hypercalcemia is also explored, encompassing both acute management and long-term strategies tailored to the underlying etiology. We assess the role of hydration, pharmacological agents, and surgical interventions, underscoring the need for individualized therapeutic plans based on the severity and underlying cause of hypercalcemia. In conclusion, the profiling of hypercalcemia is a multidimensional endeavor that necessitates a comprehensive understanding of its underlying mechanisms, diverse clinical presentations, and diagnostic intricacies. This study intends to serve as a valuable resource for healthcare professionals, offering insights into the complex terrain of hypercalcemia.
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Affiliation(s)
- Taniya Sukhija
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Vandana Midha
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Naveen Mittal
- Endocrinology, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Eva Kalra
- Medicine and Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Karan Chouhan
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Diljot Singh
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Fnu Dishant
- Medicine and Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Parmarth Attri
- Medicine and Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Manjeet K Goyal
- Gastroenterology and Hepatology, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Saurabh Arora
- Endocrinology, Dayanand Medical College and Hospital, Ludhiana, IND
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Tanné C, Pracros JP, Dijoud F, Mure PY, Bordet F, Duncan A, Bacchetta J. Severe neonatal hypercalcemia revealing congenital mesoblastic nephroma: A case report and management of neonatal hypercalcemia: Severe neonatal hypercalcemia revealing congenital mesoblastic nephroma. Arch Pediatr 2022; 29:153-156. [PMID: 35039190 DOI: 10.1016/j.arcped.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/03/2021] [Accepted: 11/30/2021] [Indexed: 11/15/2022]
Abstract
Congenital mesoblastic nephroma is a rare pediatric renal tumor and has been reported in patients presenting with palpable abdominal mass, arterial hypertension, hematuria, polyuria, or hypercalcemia. Here we present the case of a 1-month-old neonate with suspected parathyroid hormone (PTH)-related peptide (PTH-rp)-mediated severe hypercalcemia revealing congenital mesoblastic nephroma. Preoperatively, hypercalcemia was corrected with hydration, furosemide, pamidronate, and low-calcium infant formula. Unilateral nephrectomy led to the resolution of hypercalcemia, transient hyperparathyroidism, and transient vitamin D and mineral supplementation. We conclude that congenital mesoblastic nephroma can secrete PTH-rp that can cause severe hypercalcemia.
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Affiliation(s)
- C Tanné
- Pediatric and Neonatology Unit, Hôpitaux du Pays du Mont Blanc, Sallanches, France; Reference Center for Rare Diseases of Calcium and Phosphate, Reference Center for Rare Renal Diseases, ORKID, OSCAR and ERK-Net Networks for Rare Diseases, Pediatric Nephrology, Rheumatology and Dermatology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
| | - J-P Pracros
- Department of Pediatric Radiology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - F Dijoud
- Institut de Pathologie Multisite, Groupement Hospitalier Est, Hospices Civils de Lyon, France, Université Claude Bernard Lyon 1, France
| | - P-Y Mure
- Service de Chirurgie Viscérale Pédiatrique, Groupement Hospitalier Est, Hospices Civils de Lyon, France; Faculté de Médecine Lyon Est, Université Lyon 1, 69008, Lyon, France
| | - F Bordet
- Pediatric Intensive Care, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, Bron, France
| | - A Duncan
- Reference Center for Rare Diseases of Calcium and Phosphate, Reference Center for Rare Renal Diseases, ORKID, OSCAR and ERK-Net Networks for Rare Diseases, Pediatric Nephrology, Rheumatology and Dermatology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - J Bacchetta
- Reference Center for Rare Diseases of Calcium and Phosphate, Reference Center for Rare Renal Diseases, ORKID, OSCAR and ERK-Net Networks for Rare Diseases, Pediatric Nephrology, Rheumatology and Dermatology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France; Faculté de Médecine Lyon Est, Université Lyon 1, 69008, Lyon, France
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Chale-Matsau B. Humoral hypercalcaemia in an infant: a diagnostic dilemma. J Clin Pathol 2021; 74:jclinpath-2021-207392. [PMID: 33858938 DOI: 10.1136/jclinpath-2021-207392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Bettina Chale-Matsau
- Department of Chemical Pathology, University of Pretoria Faculty of Health Sciences, Pretoria, Gauteng, South Africa
- Chemical Pathology, National Health Laboratory Service, Pretoria, Gauteng, South Africa
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Abstract
Due to their daily involvement in mineral metabolism, nephrologists are often asked to consult on children with hypercalcemia. This might become even more pertinent when the hypercalcemia is associated with acute kidney injury and/or hypercalciuria and renal calcifications. The best way to assess the severity of hypercalcemia is by measurement of plasma ionized calcium, and if not available by adjusting serum total calcium to albumin concentration. The differential diagnosis of the possible etiologies of the disturbance in the mineral homeostasis starts with the assessment of serum parathyroid hormone concentration, followed by that of vitamin D metabolites in search of both genetic and acquired etiologies. Several tools are available to acutely treat hypercalcemia with the current main components being fluids, loop diuretics, and antiresorptive agents. This review will address the pathophysiologic mechanisms, clinical manifestations, and treatment modalities involved in hypercalcemia.
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Affiliation(s)
- Ari Auron
- Bone and Mineral Disorders Clinic, Division of Pediatric Nephrology, Children's Mercy Hospital, University of Missouri at Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Uri S Alon
- Bone and Mineral Disorders Clinic, Division of Pediatric Nephrology, Children's Mercy Hospital, University of Missouri at Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA.
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Abdullah AS, Adel AM, Hussein RM, Abdullah MA, Yousaf A, Mudawi D, Mohamed SF, Nashwan AJ, Soliman D, Ibrahim F, Yassin MA. Hypercalcemia and acute pancreatitis in a male patient with acute promyelocytic leukemia and pulmonary tuberculosis. Acta Biomed 2018; 89:23-27. [PMID: 29633729 PMCID: PMC6179096 DOI: 10.23750/abm.v89i3-s.7216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Indexed: 02/06/2023]
Abstract
We report a rare case of hypercalcemia and acute pancreatitis in a subject with acute promyelocytic leukemia (APL) and pulmonary tuberculosis, during all-trans-retinoic acid (ATRA) treatment. Both associated complications were potentially due to several causes. A careful monitoring and exclusion of all causative factors must be addressed. Further research is necessary to improve our understanding of risk factors for these complications in patients with (APL). Studying these patterns may help us to improve outcomes for all children and young adults with hematologic malignancies.
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Affiliation(s)
- Ali S Abdullah
- Resident, Internal Medicine, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Ahmad M Adel
- Pharmacists, Department of Pharmacy, NCCCR, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Radwa M Hussein
- Pharmacists, Department of Pharmacy, NCCCR, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Mohammed Aj Abdullah
- Hematologists, Department of Hematology, NCCCR, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Anil Yousaf
- Hematologists, Department of Hematology, NCCCR, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Deena Mudawi
- Hematologists, Department of Hematology, NCCCR, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Shehab F Mohamed
- Hematologists, Department of Hematology, NCCCR, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Abdulqadir J Nashwan
- Nurse Research Scientist, Cancer Clinical Trials Unit, NCCCR, Hamad Medical Corporation (HMC), Doha, qatar.
| | - Dina Soliman
- Department of Laboratory Medicine and Pathology, National Center for Cancer Care and Research, Hamad Medical Corporation (HMC), Doha, Qatar and Department of Clinical Pathology, National Cancer Institute, Cairo University,Cairo, Egypt.
| | - Feryal Ibrahim
- Consultant Hematopathologist Department of Laboratory Medicine and Pathology, National Center for Cancer Care and Research, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Mohamed A Yassin
- Hematologists, Department of Hematology, NCCCR, Hamad Medical Corporation (HMC), Doha, Qatar.
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Abstract
Hypercalcemia in children is a rare metabolic finding. The clinical picture is usually non-specific, and the etiology includes several entities (metabolic, nutritional, drug-induced, inflammatory, cancer-associated, or genetic) depending on the age at presentation, but severe hypercalcemia is associated mainly with malignancy in childhood and sepsis in neonates. Severe parathyroid hormone (PTH)-suppressed hypercalcemia is challenging and requires multidisciplinary diagnostic and therapeutic approaches to (i) confirm or rule out a malignant cause, (ii) treat it and its potentially dangerous complications. We report a case of severe and complicated PTH-independent hypercalcemia in a symptomatic 3-year-old boy. His age, severity of hypercalcemia and its complicated course, and the first imaging reports were suggestive of malignancy. The first bone and kidney biopsies and bone marrow aspiration were normal. The definitive diagnosis was a malignant-induced hypercalcemia, and we needed 4 weeks to assess other differential diagnoses and to confirm, on histopathological and immunochemical base, the malignant origin of hypercalcemia. Using this case as an illustrative example, we suggest a diagnostic approach that underlines the importance of repeated histology if the clinical suspicion is malignancy-induced hypercalcemia. Effective treatment is required acutely to restore calcium levels and to avoid complications.
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Affiliation(s)
- Claire Hoyoux
- Department of Pediatric Hematology and Oncology, Centre Hospitalier Regional de la Citadelle, University of Liège, Liège, Belgium
| | - Jacques Lombet
- Department of Pediatric Nephrology, Centre Hospitalier Regional de la Citadelle, University of Liège, Liège, Belgium
| | - Corina Ramona Nicolescu
- Department of Pediatric Endocrinology, Centre Hospitalier Regional de la Citadelle, University of Liège, Liège, Belgium
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Abstract
BACKGROUND Hypercalcaemia is rare in children and may present with characteristic signs/symptoms or coincidentally following investigations for a variety of non-specific conditions. The aetiologies of childhood hypercalcaemia are diverse. Untreated sustained hypercalcaemia has serious clinical consequences. However there is limited data regarding the true frequency and aetiologies of childhood hypercalcaemia. AIM To determine the frequency of severe childhood hypercalcaemia in routine clinical practice. METHODS The laboratory database was searched for all children (0-17 years) with severe hypercalcaemia defined as non-adjusted ≥2.90 mmol/L from 2007-2012. Hypercalcaemia was categorised as either transient (1 day) or sustained (≥2 consecutive days). Retrospective analysis of all cases of sustained severe hypercalcaemia was performed to identify the underlying aetiology. RESULTS Over the 5 year period, 206 children were identified as severely hypercalcaemic ≥2.90 mmol/L (0.3% all 61,380 calcium requests). Of these 131 (63.3%) children were classified as having sustained hypercalcaemia. The frequency of severe hypercalcaemia was highest in neonates (42% of sustained cases) and was inversely related to age. Sepsis was the most common aetiology (24%), particularly in neonates where it accounted for 41% of all causes of neonatal hypercalcaemia. Endocrine aetiologies included congenital adrenal hyperplasia (2 cases), fat necrosis (1), Addison's disease (2). A genetic cause was identified in 3 children (2 familial hypocalciuria hypercalcaemia, 1 Williams syndrome). CONCLUSIONS Sustained hypercalcaemia affects 1 in 500 children in a general hospital setting. The frequency was highest in neonates and underlying aetiology differed markedly with age. All children with sustained hypercalcaemia require thorough investigation to determine the underlying aetiology to ensure appropriate management.
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Affiliation(s)
- J D McNeilly
- Department of Clinical Biochemistry, Queen Elizabeth University Hospital, Greater Glasgow & Clyde NHS Trust, Glasgow, UK
| | - R Boal
- Developmental Endocrinology Research Group, Royal Hospital for Sick Children, University of Glasgow, Glasgow, UK
| | - M G Shaikh
- Developmental Endocrinology Research Group, Royal Hospital for Sick Children, University of Glasgow, Glasgow, UK
| | - S F Ahmed
- Developmental Endocrinology Research Group, Royal Hospital for Sick Children, University of Glasgow, Glasgow, UK
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Rahman SH, Papadakis GZ, Keil MF, Faucz FR, Lodish MB, Stratakis CA. Kidney Stones as an Underrecognized Clinical Sign in Pediatric Cushing Disease. J Pediatr 2016; 170:273-7.e1. [PMID: 26703870 PMCID: PMC4769940 DOI: 10.1016/j.jpeds.2015.11.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/06/2015] [Accepted: 11/16/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the prevalence of kidney stones in a population of children with Cushing disease (CD) and to compare it with the prevalence of kidney stones in healthy children. STUDY DESIGN Clinical and biochemical data from 139 pediatric patients with CD (68 females, 71 males) were analyzed retrospectively. Computed tomography scans were reviewed for kidney stones. RESULTS Among 139 patients, 27 with CD (19.4%) had either radiographic evidence and/or a history of kidney stones. Those with kidney stones had higher urine free cortisol (P = .008) and transsphenoidal surgery at an older age (P = .007). The average urinary calcium/creatinine ratio was elevated in patients with CD (0.22 ± 0.11). The prevalence of kidney stones was higher in children with CD than in normal children (19.42% vs 1.0%; P < .001). CONCLUSION Our results illustrate that kidney stones are an underestimated complication of pediatric CD, especially when compared with the prevalence of nephrolithiasis in the general pediatric population. Long-term consequences for kidney function are not known and need to be studied.
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Affiliation(s)
- Sara H. Rahman
- 1. National Institute of Child Health and Human Development (NICHD), Bethesda, MD 20814
- 2. Frank H. Netter SOM, Quinnipiac University, North Haven, Connecticut 06473,
| | | | - Margaret F. Keil
- Division of Intramural Research, National Institute of Child Health and Human Development (NICHD), Bethesda, MD 20814,
| | - Fabio R. Faucz
- Section on Endocrinology & Genetics, National Institute of Child Health and Human Development (NICHD), Bethesda, MD 20814,
| | - Maya B. Lodish
- Heritable Disorders Branch, National Institute of Child Health and Human Development (NICHD), Bethesda, MD 20814
| | - Constantine A. Stratakis
- Division of Intramural Research, National Institute of Child Health and Human Development (NICHD), Bethesda, MD 20814,
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