Life-Threatening Hypercalcemia Complicated by Pancreatitis in a Child With Acute Lymphoblastic Leukemia

Objectives Pancreatitis in children can result from metabolic and toxic risk factors, but the evidence linking these factors is sparse. We review the evidence for association or causality of these risk factors in pancreatitis, discuss management strategies and their rationale. Methods We conducted a review of the pediatric pancreatitis literature with respect to the following risk factors: (a) hyperlipidemia, (b) hypercalcemia, (c) chronic renal failure, (d) smoking exposure, (e) alcohol, and (f) medications. Areas of additional research were identified. Results Hypertriglyceridemia of 1000 mg/dl or greater poses an absolute risk for pancreatitis; persistent elevations of calcium are predisposing. Further research is necessary to determine whether end stage renal disease leads to increased pancreatitis in children similar to adults. It is unknown whether cigarette smoking exposure, which clearly increases risk in adults, also increases risk in children. The role of alcohol in pediatric pancreatitis, whether direct or modifying, needs to be elucidated. The evidence supporting most cases of medication-induced pancreatitis is poor. Drug structure, improper handling of drug by host, and by-stander status may be implicated. Other pancreatitis risk factors must be sought in all cases. Conclusions The quality of evidence supporting causative role of various toxic and metabolic factors in pediatric pancreatitis is variable. Careful phenotyping is essential, including search for other etiologic risk factors. Directed therapy includes correction/ removal of any agent identified, and general supportive measures. Further research is necessary to improve our understanding of these pancreatitis risk factors in children.

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“…Ectopic secretion of calcium-mobilizing hormones (i.e. acute lymphoblastic leukemia) has also been associated with pancreatitis (46). …”

Section: Methodsmentioning

confidence: 99%

“…For example, high intravenous calcium exposure during cardiac surgery (45) or parenteral nutrition use has been shown to cause pancreatitis. Ectopic secretion of calcium-mobilizing hormones (ie, acute lymphoblastic leukemia) has also been associated with pancreatitis (46).…”

Section: Hypercalcemiamentioning

confidence: 99%

Toxic‐metabolic Risk Factors in Pediatric Pancreatitis

Husain

Morinville

Pohl

et al. 2016

J. pediatr. gastroenterol. nutr.

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“…Acute pancreatitis in LAL is either due to hypercalcemia or post chemotherapy, but direct damage to the pancrease by leukemic cells is rarely observed. [2,3]. But in our case all these causes were ruled out.…”

Section: Dr Manju Kapoor Et Almentioning

confidence: 47%

Acute pancreatitis as presenting complication of Acute myeloid leukemia (A rare case and Literature Review)

Manju

Kapoor

Dogra

et al. 2019

CMRO

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Pancreatitis is a rare manifestation of Acute myeloid leukaemia (AML) arising during or after onset of course of disease. It can be first and only manifestation of AML. AML is a type of blood cancer. Characterized by clonal proliferation of abnormal myeloid precursors and altered normal hematopoiesis. The world Health organization (WHO) classification retains the diagnostic threshold the infiltration of the bone marrow by more than 20% of non-lymphoidblasts. We reported a case of AML discovered in a 36-year-old female admitted with chief complaints of pain epigastrium. On Clinical examination she was conscious cooperated well oriented. Blood pressure: 110/70 mmHg, abdominal examination revealed epigastric tenderness, no organomegaly. CVS, Respiratory system and neurological examination were within normal limit. On investigation amylase was 856/ UL and Lipase 690 U/L, USG abdomen suggestive of acute pancreatitis. Complete haemogram was done as base line investigation which revealed leukocytosis 1.30 lac/microlit, Hb-8 gm, platelets 32 tuousands only. The blood smear revealed the presence of circulating Blast-28, Atypical cells32%, myelocytes 7% and metamyelocytes 6% and reduced platelets. The bone marrow aspiration and biopsy suggestive of AML. Myeloperoxidase staining was positive. The patient was diagnosed as Acute pancreatitis and managed symptomatically. After improvement she was referred to PGIMER Chandigarh for further management of AML.

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“…Furthermore, severe hypercalcemia is a rare event in childhood malignancies. 9 The overall incidence of hypercalcemia at different stages of childhood malignancies is 0.4% to 1.3%. In adult malignancies, incidence of hypercalcemia during the course of the malign diseases is 20% to 30%, and it usually refers to a poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

Severe Hypercalcemia in a Child With Acute Lymphoblastic Leukemia Relapse

Tağıyev

Demirbilek²,

Tavil³

et al. 2016

Journal of Pediatric Hematology/Oncology

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Hypercalcemia is a rare complication of hematological malignancy in children. An 8-year-old girl with CALLA (+) Pre-B-cell ALL developed hypercalcemia during bone marrow relapse. She had nausea, vomiting, leg pain, polyuria, polydipsia, and muscle weakness. At the time of relapse, the ionized calcium level was 1.99 mmol/L. Rehydration with 0.9% saline and furosemide and methylprednisolone (MP) treatment were used for the treatment of hypercalcemia. The serum ionized calcium level increased to 2.2 mmol/L despite hydration, furosemide, and MP treatment. Then, a single-dose pamidronate (1 mg/kg/dose) was administered. Despite pamidronate treatment, the calcium level continued to rise. Next, calcitonin at a dose of 8 IU/kg/dose, 4 doses per day, was added to the treatment. After commencement of calcitonin treatment, her ionized calcium level decreased to normal reference ranges. In conclusion, because of the postponed effect of bisphosphonate treatment, pamidronate and calcitonin combination is an effective treatment option in the early resolution of malignancy-related hypercalcemia.

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Life-Threatening Hypercalcemia Complicated by Pancreatitis in a Child With Acute Lymphoblastic Leukemia

Cited by 8 publications

References 31 publications

Toxic‐metabolic Risk Factors in Pediatric Pancreatitis

Toxic‐metabolic Risk Factors in Pediatric Pancreatitis

Acute pancreatitis as presenting complication of Acute myeloid leukemia (A rare case and Literature Review)

Severe Hypercalcemia in a Child With Acute Lymphoblastic Leukemia Relapse

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