• Journal of Medicine and Life Science
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• 제16권1호
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• pp.31-33
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• 2019

Hypercalcemia is often seen in patients, but most of them showed mild to moderate hypercalcemia. The severe hypercalcemia with a blood calcium level of 14.0 mg/dL or more is known to be associated mainly with malignant tumors. Because this is emergency status, most clinicians tried to decrease serum calcium level to near normal range to improve symptoms related to hypercalcemia. A 71-year-old female patient visited the emergency room with dizziness and general weakness. Her serum calcium level was very high (15.6 mg/dL), but serum PTH, 25-OH vitamin D, and PTH related peptide were normal. We can exclude hyperparathyroidism, familial hypocalciuric hypercalcemia, other connective tissue diseases, and hypercalcemia due to malignant tumors as a cause of severe hypercalcemia. Conclusively, we diagnosed as severe hypercalcemia due to high-dose vitamin D injections treated one week ago. High dose vitamin D injections have recently been shown to increase the frequency of prescription as the various causes and the clinicians needed to carefully monitor the serum calcium levels in the patients after treating with high dose vitamin D.

• Childhood Kidney Diseases
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• 제21권1호
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• pp.21-25
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• 2017

Severe hypercalcemia is rarely encountered in children, even though serum calcium concentrations above 15-16 mg/dL could be life-threatening. We present a patient having severe hypercalcemia and azotemia. A 14-year-old boy with no significant past medical history was referred to our hospital with hypercalcemia and azotemia. Laboratory and imaging studies excluded hyperparathyroidism and solid tumor. Other laboratory findings including a peripheral blood profile were unremarkable. His hypercalcemia was not improved with massive hydration, diuretics, or even hemodialysis, but noticeably reversed with administration of calcitonin. A bone marrow biopsy performed to rule out the possibility of hematological malignancy revealed acute lymphoblastic leukemia. His hypercalcemia and azotemia resolved shortly after initiation of induction chemotherapy. Results in this patient indicate that a hematological malignancy could present with severe hypercalcemia even though blast cells have not appeared in the peripheral blood. Therefore, extensive evaluation to determine the cause of hypercalcemia is necessary. Additionally, appropriate treatment, viz., hydration or administration of calcitonin is important to prevent complications of severe hypercalcemia, including renal failure and nephrocalcinosis.

• Childhood Kidney Diseases
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• 제26권1호
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• pp.63-67
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• 2022

Nephrocalcinosis often occurs in infants and is caused by excessive calcium or vitamin D supplementation, neonatal primary hyperparathyroidism, and genetic disorders. Idiopathic infantile hypercalcemia (IIH), a rare cause of nephrocalcinosis, results from genetic defects in CYP24A1 or SLC34A1. Mutations in CYP24A1, which encodes 25-hydroxyvitamin D 24-hydroxylase, disrupt active vitamin D degradation. IIH clinically manifests as failure to thrive and hypercalcemia within the first year of life and usually remits spontaneously. Herein, we present a case of IIH wih CYP24A1 mutations. An 11-month-old girl visited our hospital with incidental hypercalcemia. She showed failure to thrive, and her oral intake had decreased over time since the age of 6 months. Her initial serum parathyroid hormone level was low, 25-OH vitamin D and 1,25(OH)₂ vitamin D levels were normal, and renal ultrasonography showed bilateral nephrocalcinosis. Whole-exome sequencing revealed compound heterozygous variants in CYP24A1 (NM_000782.4:c.376C>T [p.Pro126Ser] and c.1310C>A [p.Pro437His]). Although her hypercalcemia and poor oral intake spontaneously resolved in approximately 8 months, we suggested that her nephrocalcinosis and renal function be regularly checked in consideration of potential asymptomatic renal damage. Hypercalcemia caused by IIH should be suspected in infants with severe nephrocalcinosis, especially when presenting with failure to thrive.

• Asian Pacific Journal of Cancer Prevention
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• 제13권9호
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• pp.4373-4378
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• 2012

Introduction: Hypercalcemia is mainly caused by bone resorption due to either secretion of cytokines including parathyroid hormone-related protein (PTHrP) or bone metastases. However, hypercalcemia may occur in patients with or without bone metastases. The present study aimed to describe the effect of chemotherapy treatment, regimens and doses on calcium levels among breast and lung cancer patients with hypercalcemia. Methods: We carried a review of medical records of breast and lung cancer patients hospitalized in years 2003 and 2009 at Penang General Hospital, a public tertiary care center in Penang Island, north of Malaysia. Patients with hypercalcemia (defined as a calcium level above 10.5 mg/dl) at the time of cancer diagnosis or during cancer treatment had their medical history abstracted, including presence of metastasis, chemotherapy types and doses, calcium levels throughout cancer treatment, and other co-morbidity. The mean calcium levels at first hospitalization before chemotherapy were compared with calcium levels at the end of or at the latest chemotherapy treatment. Statistical analysis was conducted using the Chi-square test for categorical data, logistic regression test for categorical variables, and Spearman correlation test, linear regression and the paired sample t tests for continuous data. Results: Of a total 1,023 of breast cancer and 814 lung cancer patients identified, 292 had hypercalcemia at first hospitalization or during cancer treatment (174 breast and 118 lung cancer patients). About a quarter of these patients had advanced stage cancers: 26.4% had mild hypercalcemia (10.5-11.9 mg/dl), 55.5% had moderate (12-12.9 mg/dl), and 18.2% severe hypercalcemia (13-13.9; 14-16 mg/dl). Chemotherapy lowered calcium levels significantly both in breast and lung cancer patients with hypercalcemia; in particular with chemotherapy type 5-flurouracil+epirubicin+cyclophosphamide (FEC) for breast cancer, and gemcitabine+cisplatin in lung cancer. Conclusion: Chemotherapy decreases calcium levels in breast and lung cancer cases with hypercalcemia at cancer diagnosis, probably by reducing PTHrP levels.

• Journal of Gastric Cancer
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• 제16권3호
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• pp.191-194
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• 2016

Hypercalcemia of malignancy due to metastatic gastric adenocarcinoma is extremely rare; in fact, to the best of our knowledge, only three case reports of hypercalcemia associated with metastatic gastric adenocarcinoma have been published in the literature to date. Herein, we report a rare case involving a 61-year-old African-American female who had hypercalcemia at initial presentation and who was later diagnosed with poorly differentiated gastric adenocarcinoma with extensive liver metastases, without bone involvement. She was found to have elevated parathyroid hormone-related peptide and normal parathyroid hormone levels. Despite aggressive treatment, she died within a few months of diagnosis.

• Journal of Yeungnam Medical Science
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• 제16권2호
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• pp.208-218
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• 1999

영남대학교 의과대학 부속병원 내과에서 최근 6년간 조직학적으로 원발성 폐암이 진단되고, 알부민으로 교정한 혈청 칼슘농도가 10.5mg/dl 이상으로, 고칼슘혈증을 시사하는 임상증상이 있었던 29례를 대상으로 조직학적 소견 및 병기, 종괴의 크기, 골전이 유 무, 그리고 수행능력에 따른 혈청 칼슘농도의 차이와 혈청 칼슘농도에 따른 임상양상의 차이, 그리고 치료에 대한 반응 정도를 조사하였다. 폐암의 진단과 고칼슘혈증 발현과의 시간간격 및 고칼슘혈증이 진단된 후 생존기간 등에 대해서도 함께 고찰하여 다음과 같은 결과를 얻었다. 1) 대상환자 중 고칼슘혈증은 50대와 60대가 가장 많았으며 편평상피세포암이 대부분을 차지하였다(89.7%). 2) 고칼슘혈증은 병기가 진행될수록, 분화가 나쁠수록 유의하게 빈발하였으며, 수행등급이 나쁘거나 종괴의 크기가 클수록, 그리고 골전이가 있는 환자에서 혈청칼슘농도가 높았으나 통계학적으로 유의하지는 않았다. 3) 고칼슘혈증은 폐암진단 당시보다 진단 후 경과관찰 중 발현한 경우가 많았고, 대부분 폐암진단 후 1년 이내에 발현하였다. 4) 고칼슘혈증의 치료에 대한 반응은 치료방법에 따른 차이는 없었으나 치료에 반응한 환자군의 평균 생존기간이 유의하게 길었다. 5) 고칼슘혈증으로 진단된 폐암 환자 29례 중 27례는 고칼슘혈증 진단 후 6개월 이내 사망하였으며, 특히 진단 후 1개월 이내 사망한 경우가 68.9%로 대부분을 차지하였다. 결론적으로 고칼슘혈증은 폐암환자의 중요한 사망 원인 중 하나로 환자의 예후를 추측할 수 있는 예측인자이며, 적절한 치료로 호전될 경우 급격한 증상의 악화와 사망을 피할 수 있어 고칼슘혈증에 대한 적극적인 조사 및 치료가 필요할 것으로 생각한다.

• 한국임상약학회지
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• 제29권3호
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• pp.166-172
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• 2019

Background: Hypercalcemia is an important metabolic emergency condition in cancer patients. Bisphosphonate is the treatment of choice for hypercalcemia, whereas calcitonin and hydration with furosemide are recommended for acute supportive therapy. However, data regarding real-world treatment patterns and outcomes of pharmacological treatments are limited. Therefore, we aimed to investigate the treatment patterns and clinical outcomes of hypercalcemia treatment in solid tumor patients. Methods: Electronic medical records of 123 adults with solid cancers and albumin-corrected calcium levels >10.5 mg/dL or ionized calcium levels >1.35 mmol/L were reviewed. We retrospectively analyzed the pharmacological treatment and recovery rate according to the severity of hypercalcemia. Results: A total of 177 cases were identified, of which 49 were not treated and 30 were treated with hydration only. In moderate-to-severe cases, 86.5% received pharmacological treatment. Thirty-four cases (19.2%) were treated with bisphosphonate alone and 58 cases (32.8%) were treated with bisphosphonate and calcitonin. In mild hypercalcemia cases, the recovery rate was higher for those receiving hydration only or pharmacological treatment (79.7%) than for those receiving no treatment (61.4%, p = 0.041). Most moderate-to-severe cases were treated with medication and of those treated, 56.3% recovered. The recovery rate was lower in those treated with bisphosphonate alone (38.2%) than in those who underwent calcitonin combination treatment (73.7%, p = 0.001). Conclusions: Bisphosphonate combined with calcitonin was found to be more effective than bisphosphonate alone for the treatment of moderate-to-severe hypercalcemia. Considering the current shortage of calcitonin, further efforts are required to ensure its stable supply.

• 한국임상수의학회:학술대회논문집
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• 한국임상수의학회 2009년도 춘계학술대회
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• pp.259-259
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• 2009

• Journal of Yeungnam Medical Science
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• 제33권1호
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• pp.48-51
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• 2016

Milk-alkali syndrome (MAS), a triad of hypercalcemia, metabolic alkalosis, and renal failure, is associated with ingestion of large amounts of calcium and absorbable alkali. MAS is the third most common cause of hypercalcemia in hospital, after primary hyperparathyroidism and malignant neoplasm. MAS is not often reported in the Korean literature. We describe MAS secondary to intake of calcium citrate for the treatment of osteoporosis with thoracic spine compression fracture. A 70-year-old man presented to our hospital with a 1-week history of general weakness and lethargy. He was found with acute kidney injury (serum creatinine, 4.6 mg/dL), hypercalcemia (total calcium, 14.8 mg/dL), and alkalosis. Laboratory evaluation excluded both hyperparathyroidism and malignancy. Mental status and serum calcium level was normalized within a week after proper hydration and intravenous administration of furosemide. However, he developed aspiration pneumonia, pseudomembranous colitis, and sepsis with multi-organ failure. Despite intensive treatment including inotropics, mechanical ventilation, and renal replacement therapy, he expired with no signs of renal recovery on the 28th hospital day.

• 한국임상수의학회지
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• 제7권1호
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• pp.371-380
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• 1990

This experiment was performed to investigate the electrocardiographic changes in experimentally induced hypocalcemia and hypercalcemia in Korean black goats by dosing with 5% disodiumethylene diamine tetraacetic acid at 0.07$m\ell$/kg body weight/min and 10% Ca-borog-luconate at 0.075 $m\ell$/kg body weight/min, respectively. the result were summarized as follows： Heart rate, S-T segment and Q-Tc interval at 3.23 ${\pm}$ 0.10mEq/L plasma calcium level(hypocalcemia) were increased to 100${\pm}$10.5 rate/min, 132 ${\pm}$10msec and 510${\pm}$40msec, respectively. Heart rate, S-T segment and Q-T interval at 6.89${\pm}$0.23mEq/L plasma calcium level(hypercalcemia) were decreased to 73.2${\pm}$5.16 rate/min, 87${\pm}$10msec and 372${\pm}$30msec, respectively. The degree of changes of the heart rate, S-T segment and Q-Tc interval at low plasma calcium level was higher than those at high plasma calcium level.