Hypercalcemia in hyperthyroidism role of age and goiter type

Summary Hyperthyroidism is often associated with hypercalcemia which is provoked by osteoclastic activity of the thyroid hormones. These data show that hypercalcemia develops with increasing age and in the presence of a special type of hyperthyroid goiter. Total serum calcium, total protein, and albumin as well as different parameters of thyroid function, namely T₃ RIA¹, T₄ test, ETR and TRH test were determined in a group of 147 patients. The ionized calcium level was estimated from total calcium and albumin.211 measurements were performed. Hyperthyroidism existed in 92 cases. Total calcium was not significantly elevated in hyperthyroidism. Hyperthyroid patients under 61 years of age showed elevated ionized calcium levels in only 2.3% and patients over 60 years of age in 18.8% of cases. Elevated ionized serum calcium levels were observed in 43.8% of hyperthyroid patients with multinodular goiters. The linear correlation between ionized calcium levels and different parameters of thyroid function is much more pronounced in the older group and it was found to be highly significant. 7 of 9 hyperthyroid patients with elevated ionized calcium levels showed multinodular goiters, though no autonomous adenoma. In the hyperthyroid group of patients of over 60 years of age with multinodular goiters the incidence of hypercalcemia was 43.8%. Direct action of thyroid hormone on calcium turnover as well as increasing age and special goiter type seem to be responsible for disturbances in calcium metabolism. A possible calcitonin deficiency in the above mentioned conditions is discussed.

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Abbreviations T₃ RIA triiodothyronine radioimmunoassay - T₄ test thyroxine protein binding assay - ETR effective thyroxine ratio - TRH test stimulation test with thyrotropin-releasing hormone     

Effectiveness of lanthanum carbonate treatment used in combination with calcium carbonate in hemodialysis patients with hyperphosphatemia

Objective To evaluate the effect and safety of the combination of lanthanum carbonate and calcium carbonate in controlling the phosphate level of hemodialysis patients with hyperphosphatemia. Methods Seventy-three patients who developed hyperphosphatemia after hemodialysis were involved, and of which twelve patients complicated with hypercalcemia were put in the group without calcium. The other patients were divided into 3 groups: 21 patients in calcium carbonate group, 32 patients in lanthanum carbonate group and 20 patients in combination group. All the subjects took blood test every month. Results The level of phosphorus decreased in all the subjects participated in the trial (P＜0.01). The level of phosphatemia in combination group decreased dramatically (P＜0.01) and had little effect on calcium and parathyroid hormone. Osteoporosis and valvular calcification were the same as the begin of the trial. Conclusions The combination of lanthanum carbonate and calcium carbonate is more effective than alone. The incidences of adverse effects such as gastrointestinal, hypercalcemia, nausea, vomiting and constipation are low.     

Continuous venovenous hemodiafiltration (CWHDF) with citrate anticoagulation in the treatment of a patient with acute renal failure, hypercalcemia, and thrombocytopenia

A 72-year-old patient with multiple myeloma was admitted to the intensive care unit because of hypercalcemic crisis and acute renal failure. After 7 days of comprehensive therapy including diuretics, steroids, calcitonin, and intermittent hemodialysis (IHD) with low-calcium dialysate, calcium still reached high levels between IHD treatments and thrombocytopenia developed after chemotherapy. CVVHDF with calcium-free bicarbonate dialysate was started. Anticoagulation with 2.2 % citrate was performed in order to chelate calcium, and thus treat the hypercalcemia, and to provide regional anticoagulation, and thus reduce the risk of bleeding due to thrombocytopenia. CVVHDF with citrate anticoagulation was continued for 6 days, and standard heparin anticoagulation was started when the hypercalcemia and thrombocytopenia abated. Received: 3 July 1997 Accepted: 4 December 1997     

Cystic parathyroid presenting as an apparent thyroid goiter

Parathyroid cysts are rare lesions that can present clinically as low neck masses. The clinical diagnosis of parathyroid cyst can be challenging and requires a high level of suspicion as it often mimics a thyroid nodule. The cyst occasionally can cause compressive symptoms such as dysphagia or dyspnea. When it occurs in the mediastinum, it can cause recurrent laryngeal nerve paralysis. In this report, we present a patient with a hyperfunctional parathyroid cyst in association with a papillary thyroid carcinoma. In addition, we briefly discuss the current literature on parathyroid cyst. This case is unusual in its clinical presentation in that the parathyroid cyst mimicked a thyroid goiter.     

大剂量维生素D治疗佝偻病血25-OHD和钙镁磷的动态观察

78例活动性佝偻病患儿注射30万IU和60万IU维生素D_3后的血25-羟胆骨化醇(25-OHD)和钙镁磷的动态观察,注射后血25-OHD升高超过正常最高值(100ng/ml)的,30万IU组有14例,60万IU组有10例,3个月内仍维持在正常水平。两组各有22例和13例(均为44.8％)出现1～4次血钙升高超高正常高值(2.75mmol/1)。结果提示所用之剂量在临床上未发现中毒症状,但部分患儿出现维生素D过多症和高钙血症。特别在非维生素D缺乏佝偻病患儿用此剂量是欠安全的。     

Hypercalcemia,monoclonal protein,and osteolytic bone lesions in chronic lymphocytic leukemia

Summary We describe a patient with a long history of typical chronic lymphocytic leukemia (CLL) who developed hypercalcemia, osteolytic bone lesions, and a monoclonal protein, all features of a secretory plasma cell disorder. These features in CLL have been reported in only four previous cases. The hypercalcemia in our patient is felt to result from an increase in the osteoclastic process.     

In vitro bone resorption activity produced by a hypercalcemic adenocarcinoma tumor line (CAC-8) in nude mice

Summary Tumor extracts and conditioned tissue culture media from a canine adenocarcinoma tumor line (CAC-8) propagated in nude mice significantly increasedin vitro bone resorption in neonatal mouse calvaria as measured by release of previously incorporated⁴⁵Ca.In vitro bone resorption activity was induced in a dose-dependent manner, was not suppressible by indomethacin, and was heat- and acid-stable. Gel exclusion chromatography demonstrated peak bone resorbing activity at a relative molecular mass of approximately 28,000. The parathyroid hormone (PTH) antagonist (^8,18norleucine,³⁴tyrosine) bovine PTH (3–34) amide did not inhibit CAC 8-stimulated or (1–34) bPTH-induced bone resorption. There was an increased number of tartrate-resistant, acid phosphatase-positive cells in calvariae exposed to CAC-8 extract. Ultrastructural evaluation of calvaria revealed hypertrophy and maturation of osteoclasts in calvaria exposed to CAC-8 extract. The maturation effects included close contact to bone surfaces and the presence of clear zones and ruffled borders in osteoclasts. Similar structures were observed infrequently in osteoclasts of control calvaria. These data demonstrate that the tumor line (CAC-8) contained activity capable of stimulatingin vitro bone resorption by increasing osteoclast numbers and the activity of existing osteoclasts.     

HYPERCALCEMIA AND LIPOID PNEUMONIA

A 49-year-old man with an 11 year history of NIDDM presented hypercalcemic and with acute on chronic renal failure. His only symptoms were mild anorexia and nausea. Four years previously he had been diagnosed as haying lipoid pneumonia, with classical histological findings. On this admission, serum parathyroid hormone was suppressed and 1,25 dihydroxyvitamin D levels elevated. The cause of his hypercalcemia presumably was ectopic 1 hydroxylation of 25 hydroxyvitamin D in the chronic granulomata in his lungs. It should be emphasised that any chronic granulomatous disease, and not just sarcoidosis, may be a cause of hypercalcemia.     

益钙宁治疗高钙血症的疗效观察

用鳗降钙素类似物－益钙宁治疗１０例次７例患者高钙血症。经７天观察，血钙在４小时及２４小时均显著降低，但４８小时回升到近治疗前水平，出现“脱逸”现象，随后几天血钙波动在较高水平。