Hypercalcemia in a Patient with Polycythemia Vera

Bae, Eun Hui; Kim, Hyun Soo; Kim, Min Jee; Kang, Yong Un; Kim, Yeong Hui; Kim, Chang Seong; Choi, Joon Seok; Kwon, Seong; Kim, Soo Wan

doi:10.4068/cmj.2012.48.2.128

Cited by 5 publications

(4 citation statements)

References 4 publications

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“…Although this evidence provides an explanation for the mechanism of dual-phase 99m Tc-MIBI parathyroid imaging, it is likely that other factors are involved. As preoperative localization of abnormal parathyroid glands by dual-phase 99m Tc-MIBI imaging may improve patient outcomes and reduce the duration and cost of surgery for HPT, further investigations are warranted 17 , 18 .…”

Section: Introductionmentioning

confidence: 99%

Dual-phase 99mTc-MIBI imaging and the expressions of P-gp, GST-π, and MRP1 in hyperparathyroidism

Xue

Liu²,

Yang³

et al. 2017

Nuclear Medicine Communications

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ObjectiveThe aim of this study was to further elucidate the mechanisms of dual-phase technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) parathyroid imaging by exploring the association between early uptake results (EUR), delayed uptake results (DUR), and the retention index (RI) in dual-phase 99mTc-MIBI parathyroid imaging and P glycoprotein (P-gp), multidrug resistance-associated protein 1 (MRP1), and glutathione S-transferase-π (GST-π) expression in hyperparathyroidism (HPT).Patients and methodsPreoperative dual-phase (early and delayed) 99mTc-MIBI imaging was performed on 74 patients undergoing parathyroidectomy for HPT. EUR, DUR, and RI were calculated. P-gp, MRP1, and GST-π expressions were assessed using immunohistochemistry in resected tissue from HPT and control patients. The association between P-gp, MRP1, and GST-π expressions and EUR, DUR, and RI in HPT was evaluated.ResultsThe positive rate of dual-phase 99mT c-MIBI imaging was 91.89% (68/74) and the false-negative rate was 8.11% (6/74). P-gp and GST-π expressions were higher in tissues resected from control compared with HPT patients (47.37 and 81.5%, P<0.05); there was no difference in MRP1. EUR were associated with P-gp and GST-π expressions, and DUR were associated with MRP1 expression. There was a significant difference in MRP1 expression between RI greater than or equal to 0 and RI less than 0. There was no relationship between the sensitivity of dual-phase 99mTc-MIBI imaging and P-gp, MRP1, and GST-π expressions in resected parathyroid tissue. The six false-negative HPT cases consisted of three P-gp (−)/MRP1 (−) tissues, three P-gp (−)/GST-π (−) tissues, and four MRP1 (−)/GST-π (−) tissues.ConclusionAs P-gp and GST-π expressions were higher in tissues resected from control compared with HPT patients, 99mTc-MIBI may wash out faster from normal parathyroid tissue surrounding the lesion compared with the lesion itself, facilitating detection.

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Section: Introductionmentioning

confidence: 99%

Dual-phase 99mTc-MIBI imaging and the expressions of P-gp, GST-π, and MRP1 in hyperparathyroidism

Xue

Liu²,

Yang³

et al. 2017

Nuclear Medicine Communications

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“…Hypercalcemia occurring by different mechanisms has been reported in association with polycythemia vera. Several studies have reported an association between polycythemia vera and primary hyperparathyroidism, with resolution of polycythemia following surgical removal of a parathyroid adenoma or a parathyroid carcinoma . These reports antedate JAK2 mutation testing, and these patients may possibly not have had polycythemia vera, but rather secondary polycythemia, with the parathyroid lesions possibly stimulating or secreting erythropoietin.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have reported an association between polycythemia vera and primary hyperparathyroidism, with resolution of polycythemia following surgical removal of a parathyroid adenoma or a parathyroid carcinoma. [5][6][7][8] These reports antedate JAK2 mutation testing, and these patients may possibly not have had polycythemia vera, but rather secondary polycythemia, with the parathyroid lesions possibly stimulating or secreting erythropoietin. An association between parathyroid adenomas and polycythemia vera was identified in a historical cohort study, 9 but it is again unclear whether these cases represented polycythemia vera or secondary polycythemia.…”

Section: Discussionmentioning

confidence: 99%

Development of Hypercalcemia in a Patient Receiving Peginterferon alfa‐2a Therapy for Polycythemia Vera

Karne

Mainor

2016

Pharmacotherapy

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Peginterferon alfa-2a (PEG-IFN alfa-2a) is commonly used to treat hepatitis C virus infection and is also being used increasingly to treat myeloproliferative neoplasms including polycythemia vera. Sarcoidosis associated with IFN therapy for treatment of hepatitis C is well described, with hypercalcemia occurring as a rare manifestation. We describe a 25-year-old man with polycythemia vera who became resistant to hydroxyurea after 6 years of treatment, requiring therapeutic phlebotomy procedures with increasing frequency for elevated hemoglobin and hematocrit levels. PEG-IFN alfa-2a was then initiated at 90 μg subcutaneously once/week and was progressively increased to 180 μg/week over the next 11 months, with normalization of his hemoglobin and hematocrit. The patient then developed hypercalcemia with low parathyroid hormone, parathyroid hormone-related protein, and 25-hydroxyvitamin D levels, and high 1,25-dihydroxyvitamin D and angiotensin-converting enzyme levels, without other evidence of sarcoidosis. PEG-IFN alfa-2a was discontinued, treatment with intravenous fluids and zoledronic acid was initiated, and the hypercalcemia resolved 10 weeks later. Use of the Naranjo Adverse Drug Reaction Probability Scale indicated a probable relationship (score of 7) between the patient's development of hypercalcemia and PEG-IFN alfa-2a therapy; the relationship could not be considered as definite because the patient was not rechallenged with the drug. To our knowledge, this is the first case report of IFN-induced hypercalcemia without other manifestations of sarcoidosis. Practitioners should be aware of hypercalcemia as a potential complication of PEG-IFN alfa-2a therapy, as well as its protracted time course, in patients with myeloproliferative neoplasms.

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“…The parathyroid tumour may have produced or induced the production of a growth factor that can stimulate pancytosis. [ 7 ] Tiryakioglu et al . suggested that the calcium-PTH axis is important for the activation of erythropoiesis.…”

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confidence: 99%

Improvement in polycythaemia vera after parathyroidectomy for primary hyperparathyroidism

Sthaneshwar¹,

Zainuddin²,

Ratnasingam³

2022

Singapore Medical Journal

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Hypercalcemia in a Patient with Polycythemia Vera

Cited by 5 publications

References 4 publications

Dual-phase 99mTc-MIBI imaging and the expressions of P-gp, GST-π, and MRP1 in hyperparathyroidism

Dual-phase 99mTc-MIBI imaging and the expressions of P-gp, GST-π, and MRP1 in hyperparathyroidism

Development of Hypercalcemia in a Patient Receiving Peginterferon alfa‐2a Therapy for Polycythemia Vera

Improvement in polycythaemia vera after parathyroidectomy for primary hyperparathyroidism

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