Severe hypercalcemia as a presenting sign of systemic lupus erythematosus

Farah, Raymond; Farah, Rola; Makhoul, Nicola

doi:10.1016/j.ejim.2005.09.025

Cited by 8 publications

(13 citation statements)

References 4 publications

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“…Among 17 cases reported, there were 15 females and 2 males (7, 15); 1 mild hypercalcemia (7) (male), 5 moderate hypercalcemia (2, 8, 12, 15, 16) (1 male and 4 females), 11 severe hypercalcemia (1, 3–6, 9–11, 13, 14, 17) (all females); 2 children (all females) (6, 9), 15 adults; there were 14 cases of hypercalcemia in active stage of SLE, 3 cases of hypercalcemia in remission stage of SLE (3, 6, 12) (all female, 2 of them considered the main cause of non-hypercalcemia in SLE); 15 cases of SLE-related hypercalcemia (1, 2, 4–11, 13–17), and 1 case of hypercalcemia were caused by primary hyperthyroidism (3), The coexistence of SLE and hypercalcemia was considered in only 1 case (3); SLE with PTH elevation in 5 cases [including 3 cases of parathyroid adenoma (1, 6, 12), 1 case of parathyroid cyst (3), 1 case was caused by autoantibody of calcium sensitive receptor (9)], SLE with PTHrP elevation in 3 cases (2, 15, 17); 1 case may be caused by false negative PTHrP (11), 2 cases may be caused by anti-PTHrP (4, 8), 5 cases may be caused by PTH-related protein and autoantibodies (7, 10, 13, 14, 16), 1 case may be related to the decrease of fibroblast growth factor 23 (5); 10 cases had increased serum creatinine or decreased creatinine clearance (2, 4–7, 9–11, 13, 15), 5 cases had LN (7, 9, 10, 13, 15); 7 cases had SLE variants, which were described as hypercalcemia-lymphedema Syndrome, characterized by hypercalcemia and serositis (4, 8, 13–17). Among them, 1 case was positive for PTHrP by lymph node biopsy (15); 6 cases were complicated with ectopic calcification (2–4, 9, 10, 13,…”

Section: Literature Review and Discussionmentioning

confidence: 99%

Lupus Nephritis With Mild Asymptomatic Hypercalcemia in Children: A Case Report and Literature Review

Zhang

et al. 2019

Front. Pediatr.

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Lupus nephritis (LN) in Children is caused by Kidney involvement in systemic lupus erythematosus (SLE). SLE is a chronic, multi-systemic, paroxysmal autoimmune disease with a wide spectrum of autoantibodies. Hypercalcemia is a common manifestation of primary hyperparathyroidism and other malignant tumors. LN or SLE with hypercalcemia is rare. We report a case of LN with hypercalcemia and review the literature. It suggests that the pathogenesis of SLE complicated with hypercalcemia complicates the response of drug therapy.

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Section: Literature Review and Discussionmentioning

confidence: 99%

Lupus Nephritis With Mild Asymptomatic Hypercalcemia in Children: A Case Report and Literature Review

Zhang

et al. 2019

Front. Pediatr.

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“…SLE is a very rare cause of hypercalcemia, with only ten cases reported (9) (10). The pathogenesis involves the presence of stimulatory anti-PTH receptor autoantibodies or excessive endogenous production of PTHrP primarily due to lymphadenopathy (10) (11).…”

Section: Discussionmentioning

confidence: 99%

“…The pathogenesis involves the presence of stimulatory anti-PTH receptor autoantibodies or excessive endogenous production of PTHrP primarily due to lymphadenopathy (10) (11). Interestingly, SLE was also found to coexist with hypoparathyroidism, with four cases reported in literature (12).…”

Section: Discussionmentioning

confidence: 99%

Functional parathyroid cyst in a patient with systemic lupus erythematosus: a case report

Jiang

Zhang

et al. 2015

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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SummaryFunctional parathyroid cysts are a rare cause of primary hyperparathyroidism and are often mistaken for thyroid cysts. Systemic lupus erythematosus (SLE) is also a very rare cause of hypercalcemia. We report the case of a 62-year-old woman, who was diagnosed with SLE 30 years ago, presenting with clinical and biochemical features of primary hyperparathyroidism. Laboratory investigation revealed increased serum calcium and parathyroid hormone (PTH) levels; neck ultrasonography (USG) revealed 40×34×26 mm cystic mass in the left lobe of thyroid gland. PTH level in the cysts was >2500 pg/ml, determined by USG-guided fine-needle aspiration (FNA). In this case, no evidence for potential pathogenic association between parathyroid cyst and SLE was uncovered. However, the recognition of this association is very important because the therapeutical strategy is completely different. Operative management is usually straightforward and alleviates symptoms and any biochemical abnormalities caused by the cyst.Learning points Functional parathyroid cysts are the rare cause of primary hyperparathyroidism and are often mistaken for thyroid cysts.SLE is also a very rare cause of hypercalcemia.Ultrasound-guided FNA of cystic fluid with assay for PTH level is an accurate method of differentiating parathyroid cyst from thyroid cyst.Appropriate management of functional parathyroid cysts is surgical excision.

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“…8 The association of hypercalcemia with SLE is limited to reports involving adult subjects. [1][2][3][4][5] Its pathogenesis is attributed to high blood levels of PTH, 1 presence of stimulatory PTH-receptor antibodies 2 and PTH-related peptide, 3 or sarcoidosis. The presence of hypercalcemia, hypophosphatemia and elevated levels of PTH in the present patient suggest that these were not secondary to circulating peptide or receptor autoantibodies, since these conditions characteristically show low levels of PTH.…”

Section: Discussionmentioning

confidence: 99%