China
Africa
Explore chapters and articles related to this topic
Renal Metastasis
Published in Kelechi Eseonu, Nicolas Beresford-Cleary, Spine Surgery Vivas for the FRCS (Tr & Orth), 2022
Kelechi Eseonu, Nicolas Beresford-Cleary
It is essential to measure blood calcium as malignant hypercalcaemia can be a medical emergency associated with metastatic bone disease. (Symptoms include confusion, muscle weakness, nausea and polydipsia/polyuria). In a patient where a spinal lesion was seen, without the identification of a primary tumour, a CT-guided biopsy would be necessary to rule out a primary bone lesion.
Renal and Electrolytes
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
There are many causes of hypercalcaemia. Ninety percent of causes are due to either: Primary hyperparathyroidism (Table 7.5.1)Malignancy (most commonly breast cancer, lung cancer and multiple myeloma)
The Injured Cell
Published in Jeremy R. Jass, Understanding Pathology, 2020
Metastatic calcification occurs in normal tissues in subjects with hypercalcaemia. Common causes of hypercalcaemia include overproduction of parathyroid hormone (for example by a parathyroid adenoma), vitamin D intoxication and excessive consumption of alkali. Metastatic calcification is most common in sites of ion exchange: alveoli of lung, gastric mucosa and renal tubules.
Parathyroid carcinoma in chronic renal disease – a case series of three patients and review of literature
Published in Acta Chirurgica Belgica, 2023
Vladan Zivaljevic, Rastko Zivic, Nikola Slijepcevic, Matija Buzejic, Dusko Dundjerovic, Jasna Trbojevic Stankovic, Dejan Stojakov, Milan Jovanovic, Ivan Paunovic
The average levels of PTH in haemodialysis patients are usually very high and range from two to nine times above the upper normal limit. According to the National Kidney Foundation, PTH levels exceeding 800 ng/L are one of the main indications for surgery [35]. PTH levels in patients with ESRD are highly elevated but often measured with different assays. The highest level of PTH was reported by Cabane et al. at 2287 ng/L [29]. Our cases showed maximum PTH levels of 1901, 1337, and 982 ng/L, 15 times above the normal upper limit. In all reported patients, PTH levels were always at least 6 times higher compared to normal values (Table 1). Of all reported patients, the mean calcium level was 2.89 mmol/L (range 2.12–5.00). Remarkably, only 77% of patients presented with hypercalcaemia. These values indicate that patients who have hypercalcaemia refractory to haemodialysis with mildly to highly elevated PTH levels might suffer from parathyroid carcinoma. All three patients in our case series developed hypercalcaemia at some point before surgery. Unfortunately, data on phosphate levels were missing for most cases, but when reported it was only mildly elevated. Increased phosphate levels are also one of the contributing factors when considering surgery for hyperparathyroidism in ESRD patients [35].
Biosimilarity of HS-20090 to Denosumab in healthy Chinese subjects: a randomized, double-blinded, pharmacokinetics/pharmacodynamics study
Published in Expert Opinion on Investigational Drugs, 2022
Yaqi Lin, Heng Yang, Xiaoyan Yang, Can Guo, Shuang Yang, Guoping Yang, Qiong Wu, Chao Pan, Changan Sun, Chuan Li, Liangliang He, Jie Huang, Qi Pei
Denosumab binds to RANKL, thereby modulating calcium release from bone. Normal serum calcium levels are 8–10 mg/dL (2.0–2.5 mmol/L), although the exact range can vary among laboratories [13]. In this study, normal serum calcium levels are 2.2–2.7 mmol/L. When the total serum calcium level is at concentrations of 2.1 mmol/L or less, it was considered hypocalcemia. Hypercalcemia is judged by our research doctor if the total serum calcium level is higher than 2.8 mmol/L. Both of them are graded according to the CTCAE. Reduced release of calcium from the bone eventually leads to hypocalcemia. However, several subjects had the hypercalcemia during the study, which might be the rebound-linked phenomenon after Denosumab discontinuation [14]. In addition, Denosumab could also affect the parathyroid gland function. Increased blood parathyroid hormone was observed in this study, which might be a compensatory response to the transient dose-dependent decrease in serum calcium levels [15]. The increased PTH levels might lead to an increased phosphorus excretion in the absence of osteoclastic liberation of bone phosphorus, consequently resulting in a hypophosphatemia [16].
Bone health in patients undergoing surgery for primary hyperparathyroidism at Tygerberg Hospital, Cape Town, South Africa
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2021
M Budge, W Conradie, K Beviss-Challinor, L Martin, M Conradie, A Coetzee
Baseline biochemistry is given in Table 2. All but one patient had elevated calcium levels (median: 2.93 mmol/l [2.81; 3.19]) and the vast majority (n = 53; 94.6%) displayed a calcium concentration of > 2.75 mmol/l. The single patient with normocalcaemia (calcium level 2.45 mmol/l) had a PTH of 12.9 pmol/l and symptoms attributable to hypercalcaemia (normocalcaemic hyperparathyroidism). Severe hypercalcaemia (> 3.50 mmol/l) was seen in 14.3% of patients. Concomitant decreased phosphate concentrations (mean: 0.87 ± 0.24 mmol/l) were seen in 20 patients (35.7%). Parathyroid hormone levels exceeded the reference interval in all but two patients (54; 96.4%). These two patients had PTH values in the upper half of the normal range (PTH 4.1 and 5.9 pmol/l; reference interval 1.6–6.9 pmol/l), deemed inappropriate given the elevated calcium level.