HYPERCALCAEMIA IN HOSPITAL PATIENTS Clinical and Diagnostic Aspects

Fisken, Roger A; Heath, D. A.; Somers, Stephanie; Bold, Adriana

doi:10.1016/s0140-6736(81)90071-4

Cited by 111 publications

(27 citation statements)

References 22 publications

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“…Hypercalcemia is a secondary metabolic phenomenon occurring in approximately 58% of hospitalized patients with cancer [1].Thiscomplicationisdefinedasmalignancy-associatedhypercalcemia(MAH)andcanbecategorizedintotwo cardinal groups: the humoral hypercalcemia of malignancy (HHM),duetosystemicboneresorptionbyseveralhumoral factorsproducedandsecretedbythemalignanttumoritself, andthelocalosteolytichypercalcemiaofmalignancy(LOH), duetolocalosteolysisinducedbybonemetastasis [2].Many studiesoverthelastdecadeshavereachedtheconclusionthat the major agent inducing HHM is the so-called parathyroid hormone-related peptide (PTH-rP) [3]. PTH-rP was discoveredinthemid1980s,thusestablishinganimportantadvancementintheunderstandingofmalignancy-associatedhypercalcemias [4].PTH-rPisexpressedandsecretedbyavarietyof normal human tissues, including amnion, chorion, placenta, myometrium and decidua during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Paraneoplastic Humorally Mediated Hypercalcemia Induced by Parathyroid Hormone-Related Protein in Gynecologic Malignancies: A Systematic Review

et al. 2009

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Humoral hypercalcemia of malignancy (HHM) is a metabolic phenomenon that is mediated by the paraneoplastic secretion of parathyroid hormone-related peptide (PTHrP). Gynecologic malignant neoplasms complicated by HHM have been reported for organs such as the uterus, cervix, ovary, vulva and the vagina. The purpose of our study was to perform a review of the published cases in the literature and, further, to identify parameters with effect on outcome. Among 34 women with gynecologic neoplasms, 22 suffered from ovarian and 6 from uterine malignancies, while 3 had vulvar and another 3 cervical cancer. Furthermore, clear cell carcinoma was the predominant histology associated with PTH-rP expression. A significant correlation was found between serum calcium and PTH-rP levels. Treatment of hypercalcemia was successful in all cases; pamidronate was utilized in 8 patients. Ovarian cancer patients with severe hypercalcemia and high PTH-rP serum levels had shorter survival compared to their counterparts with mild hypercalcemia or moderately elevated PTH-rP serum levels, but the differences were not statistically significant.

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Section: Introductionmentioning

confidence: 99%

Paraneoplastic Humorally Mediated Hypercalcemia Induced by Parathyroid Hormone-Related Protein in Gynecologic Malignancies: A Systematic Review

et al. 2009

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“…The most common causes of hypercalcemia in hospital patients without a known diagnosis are either hyperparathyroidism or malignancy [6]. Fisken et al evaluated 166 hospital inpatients with hypercalcemia at admission.…”

Section: Differential Diagnosismentioning

confidence: 99%

“…Tumors most frequently associated with hypercalcemia are carcinomas of the lung or breast, tumors of the genitourinary tract, and those of unknown origin [6,12,20]. Because there were no abnormalities on the chest X-ray, X-ray of the vertebral column, computed tomographic scans of the thorax and abdomen, or the mammogram, these conditions appeared less likely.…”

Section: Differential Diagnosismentioning

confidence: 99%

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A 78-year-old women with hypercalcemia now and malignancy of unknown origin 11 years ago

Royen

Westedt

Ottolander

et al. 1998

Annals of Hematology

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Presentation of caseA 78-year-old Caucasian woman was admitted to our hospital with anorexia, nausea, and weight loss (9 kg) of 9 month's duration. Eleven years ago she had been admitted to another hospital with clinical signs of acute spinal cord compression. An X-ray of the vertebral column showed partial destruction of thoracic vertebrae V and VI. A cervical myelogram revealed complete stenosis at the level of thoracic segments IV and V. On the day of admission she underwent laminectomy of vertebrae III, IV, and V. Histological examination of the surgical specimens showed malignancy of unknown origin. At that time, differentiation between (metastatic) carcinoma and lymphoma was not possible. There was no evidence of an existing primary tumor. Postoperative local irradiation was administered for 4 weeks (40 Gy) at the level of thoracic segments IV and V. She recovered completely within 3 months.Her medical history has been uneventful since then, except for regular visits to the rheumatology outpatient clinic because of osteoporosis with thoracic kyphosis and back pains during the past year. She takes 400 I.U. vitamin D 3 (cholecalciferol) 1000 mg calcium daily.On physical examination we saw a fragile-looking woman, height 168 cm, weight 62 kg. Her pulse rate was 72 beats per minute, blood pressure 165/90 mm Hg. Her temperature was 36.8 7C; central venous pressure was not elevated.Auscultation of the heart revealed a systolic murmur II/VI with maximum intensity at the cardiac apex, radiating to both carotid arteries. Auscultation and percussion of the lungs were normal. There were no palpable abnormalities of the mammae. The abdomen was not distended, and liver and spleen were not palpable. Palpation of the abdomen revealed no abnormalities. Enlarged lymph nodes were not found.The erythrocyte sedimentation rate was 29 mm after the first hour, the hemoglobin concentration 7.1 mmol/l (normalp7.4-10.2 mmol/l), mean corpuscular volume 91 fl (normalp80-100 fl), white blood cell count 8.0/nl (normalp 4.0-10.0/nl), and platelet count 135/nl (normalp150-400/nl). A blood smear showed 80% neutrophils,11% lymphocytes, 9% monocytes, 1% eosinophils, and 0% basophils. Urinalysis revealed no abnormalities in the sediment. Bence Jones protein was not detected. Creatinine clearance was 34 ml/min.

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“…In most clinical situations hypercalcemia is caused by primary hyperparathyroidism (PHP) or malignancy [1,2]. Because the excretion of urinary cAMP (cyclic 3',5' adenosine monophosphate) has been proved to be a good measurement of the biological activity of parathyroid hormone (PTH) in PHP some investigators started measuring urinary cAMP excretion in hypercalcemic patients with a malignant tumor in an attempt to differentiate between the hypercalcemia of PHP and of malignancy [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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2017

EMIJ

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In this mini-review the role of parathyroid hormone-related peptide (PTHrP) in physiology and pathophysiology is discussed. Evolving from an unknown humoral factor in the HHM (Hypercalcemia of malignancy) syndrome its role as a "masterregulator" in the PTH family following identification is reviewed. PTHrP has more paracrine and autocrine functions in virtually all tissues than classical endocrine functions and is essential in embryonic, fetal and post-natal life. The physiological functions are near endless. The development of PTH/PTHrP receptor antagonist and agonists has been difficult and disappointing. Its role as a possible cytokine itself and as a regulatory thermogenesis factor in brown adipose tissue in cancer cachexia is discussed. PTHrP assays must be improved for PTHrP to be a reliable biomarker in oncology and to resolve the function of local proteolytic PTHrP fragments which are largely a mystery until now.

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HYPERCALCAEMIA IN HOSPITAL PATIENTS Clinical and Diagnostic Aspects

Cited by 111 publications

References 22 publications

Paraneoplastic Humorally Mediated Hypercalcemia Induced by Parathyroid Hormone-Related Protein in Gynecologic Malignancies: A Systematic Review

Paraneoplastic Humorally Mediated Hypercalcemia Induced by Parathyroid Hormone-Related Protein in Gynecologic Malignancies: A Systematic Review

A 78-year-old women with hypercalcemia now and malignancy of unknown origin 11 years ago

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