Despite advancements in the field,early diagnosis of multiple endocrine neoplasia type 1(MEN1)remains unachievable.This letter to the editor highlighted the importance of carefully assessing gastrointestinal symptoms,...Despite advancements in the field,early diagnosis of multiple endocrine neoplasia type 1(MEN1)remains unachievable.This letter to the editor highlighted the importance of carefully assessing gastrointestinal symptoms,hypercalcemia,and elevated serum gastrin levels,as suggested by Yuan et al in their paper.They focused on a patient with recurrent abdominal pain and diarrhea whose diagnostic path led to establishing a MEN1 diagnosis within a year.This emphasized the need for clinicians to consider MEN1 in patients with similar presentations,particularly when gastrointestinal symptoms persist or recur after discontinuation of proton pump inhibitors,especially knowing that early recognition and intervention are crucial for improving patient outcomes.展开更多
BACKGROUND Calcitriol-induced hypercalcemia has been rarely reported in cases of lung cancer;however,it is frequently reported in cases of lymphoid malignancy and granulomatous disease.We present a rare case of hyperc...BACKGROUND Calcitriol-induced hypercalcemia has been rarely reported in cases of lung cancer;however,it is frequently reported in cases of lymphoid malignancy and granulomatous disease.We present a rare case of hypercalcemia associated with squamous cell cancer of the lung with elevated calcitriol level.CASE SUMMARY A 61-year-old Caucasian female with severe hypercalcemia of 15 mg/dL,which led to a new diagnosis of metastatic lung cancer.Since the parathyroid hormonerelated peptide(PTHrP)level was minimally elevated at 2.1 pmol/L,we believe excessive calcitriol production by tumor cells was the underlying mechanism for hypercalcemia.Calcitriol was significantly elevated at 130 pg/mL with a low 25-hydroxyvitamin D level of 25.9 ng/mL and suppressed PTH level of 8 pg/mL.Corticosteroids are generally used to treat calcitriol-induced hypercalcemia,but we successfully treated our patient with bisphosphonate,highlighting the further utility of bisphosphonates in hypercalcemia treatment.CONCLUSION We believe that the underlying cause of hypercalcemia,in this case of metastatic squamous cell lung carcinoma,was elevated calcitriol,which was likely produced by the tumor cells.In addition to PTHrP,calcitriol levels should be included in the workup for hypercalcemia in cases of lung cancer.However,the pathophysiology and prognostic significance of dysregulated calcitriol production in solid tumors remain unclear and warrant further research.Bisphosphonate may be used as a steroid-sparing therapy even in cases of calcitriol-induced hypercalcemia and warrants further investigation.展开更多
BACKGROUND The association between primary hyperparathyroidism (PHPT) and acute pancreatitis is rarely reported.Here we describe the process of acute pancreatitismediated PHPT induced by hypercalcemia in a male patien...BACKGROUND The association between primary hyperparathyroidism (PHPT) and acute pancreatitis is rarely reported.Here we describe the process of acute pancreatitismediated PHPT induced by hypercalcemia in a male patient.Hypercalcemia induced by undiagnosed PHPT may be the causative factor in recurrent acute pancreatitis.CASE SUMMARY We report a case of hypercalcemia-induced acute pancreatitis caused by a functioning parathyroid adenoma in a 57-year-old man.The patient initially experienced a series of continuous gastrointestinal symptoms including abdominal distension,abdominal pain,nausea,vomiting,electrolyte disturbance,renal dysfunction,and acute pancreatitis.Due to prolonged hypercalcemia,the patient subsequently underwent surgical resection of the parathyroid adenoma.Two weeks after surgery,his serum calcium,amylase,and lipase concentrations were normal.The patient had a good recovery after a series of other relevant therapies.CONCLUSION Acute pancreatitis as the first presentation is a rare clinical symptom caused by PHPT-induced hypercalcemia.展开更多
Parathyroid hormone mediated hypercalcemia is not always exclusively primary hyperparathyroidism and rarely could be due to ectopic parathyroid hormone secretion from tumor cells.We present a case of 86-yearold female...Parathyroid hormone mediated hypercalcemia is not always exclusively primary hyperparathyroidism and rarely could be due to ectopic parathyroid hormone secretion from tumor cells.We present a case of 86-yearold female with metastatic gall bladder adenocarcinoma diagnosed eight months back who presented with generalized fatigue and poor oral intake and was found to be hypercalcemic with elevated parathyroid hormone levels.Imaging with technetium 99 m sestamibi scintigraphy with dual phase,subtraction thyroid scan(dual isotope scintigraphy),magnetic resonance imaging and ultrasonography did not demonstrate any parathyroid lesion in normal or ectopic sites.We believe that the tumor cells were the source of ectopic parathyroid hormone secretion as we had excluded all the other possibilities with extensive combined imaging thereby increasing the sensitivity of our testing.We report the first case of metastatic gall bladder adenocarcinoma with paraneoplastic ectopic parathyroid hormone secretion.展开更多
Objective： To evaluate the efficacy and toleration of bisphosphonates therapy in patients with bone metastases and hypercalcemia of malignancy in advanced solid tumor. Methods： Patients with histologically or cytolo...Objective： To evaluate the efficacy and toleration of bisphosphonates therapy in patients with bone metastases and hypercalcemia of malignancy in advanced solid tumor. Methods： Patients with histologically or cytologically confirmed cancer and hypercalcemia with bone metastases were designed to open treatment with either 4mg zoledronic acid or 90mg pamidronate. The primary efficacy parameters were pain scores（NRS）, Corrected serum calcium（CSC） and CSC effective rate The vital signs, biochemical and hematological parameters were determined. Results： Twenty patients were enrolled in this study, twelve patients in zoledronic acid group and eight in pamidronate group. Zoledronic acid and pamidronate significantly palliated pain. Pain scores were significantly lower at end-point after Zoledronic acid or pamidronate infusion（5.92 vs 3.25, P〈0.01; 6.13 vs 4.38, P〈0.01, respectively）. The mean CSC level decreased significantly after Zoledronic acid or pamidronate infusion from 12.86 to 10.28mg/dl and 13.19 to 10.36mg/dl respectively. The CSC effective rate was about 90% at 14 days after infusion in two groups. There was no statistical significance for all primary efficacy parameters in zoledronic acid group compared with pamidronate group. An adverse reaction was mild fever after pamidronate infusion and then completely reversible. Conclusion： Zoledronic acid and pamidronate disodium were well tolerated and effective for bone metastases and hypercalcemia of malignancy in advanced solid tumor.展开更多
BACKGROUND Although acute pancreatitis associated with hyperparathyroidism has occasionally been reported,acute pancreatitis with metabolic encephalopathy caused by hyperparathyroidism combined with paraneoplastic syn...BACKGROUND Although acute pancreatitis associated with hyperparathyroidism has occasionally been reported,acute pancreatitis with metabolic encephalopathy caused by hyperparathyroidism combined with paraneoplastic syndrome is an extremely rare entity and poorly described in the literature.CASE SUMMARY We present a case of a 56-year-old female with upper abdominal discomfort and intermittent nausea and vomiting for 1 wk,without apparent abdominal pain or bloating,no jaundice and decreased blood pressure at the outset.The patient was ultimately diagnosed with moderately severe acute pancreatitis(according to the revised Atlanta classification of acute pancreatitis)combined with metabolic encephalopathy secondary to hypercalcemia caused by primary hyperparathyroidism associated with paraneoplastic syndrome.After active treatment of acute pancreatitis,massive fluid resuscitation,resection of parathyroid and uterine malignant tumors,neoadjuvant chemotherapy and other treatments,her serum calcium eventually returned to the normal level.The patient was successfully discharged from hospital.CONCLUSION This is the first case of acute pancreatitis caused by primary hyperparathyroidism associated with paraneoplastic syndrome.展开更多
Familial hypocalciuric hypercalcemia （FHH） is caused by inactivating mutations in the calcium-sensing receptor （CaSR） gene. The loss of function of CaSR presents with rickets as the predominant skeletal abnormalit...Familial hypocalciuric hypercalcemia （FHH） is caused by inactivating mutations in the calcium-sensing receptor （CaSR） gene. The loss of function of CaSR presents with rickets as the predominant skeletal abnormality in mice, but is rarely reported in humans. Here we report a case of a 16-year-old boy with FHH who presented with skeletal manifestations of rickets. To identify the possible pathogenic mutation, the patient was evaluated clinically, biochemically, and radiographicaUy. The patient and his family members were screened for genetic mutations. Physical examination revealed a pigeon breast deformity and X-ray examinations showed epiphyseal broadening, both of which indicate rickets. Biochemical tests also showed increased parathyroid hormone （PTH）, 1,25-dihydroxyvitamin D, and elevated ionized calcium. Based on these results, a diagnosis of FHH was suspected. Sequence analysis of the patient＇s CaSR gene revealed a new missense mutation （c.2279T 〉 A） in exon 7, leading to the damaging amino change （p.I760N） in the mature CaSR protein, confirming the diagnosis of ~H. Moreover, the skeletal abnormities may be related to but not limited to vitamin D abnormity. Elevated ~H levels and a rapid skeletal growth period in adolescence may have also contributed. Our study revealed that rickets-like features have a tendency to present atypically in FHH patients who have a mild vitamin D deficiency, and that CaSR mutations may have a partial role in the pathogenesis of skeletal deformities.展开更多
The hypercalcemias are a common and heterogeneous group of disorders, ranging from the occasional detection of a high level of serum calcium to a life-treating condition. In a patient presenting with hypercalcemia, a ...The hypercalcemias are a common and heterogeneous group of disorders, ranging from the occasional detection of a high level of serum calcium to a life-treating condition. In a patient presenting with hypercalcemia, a differential diagnosis can be established easily by measuring serum calcium and parathyroid hormone(PTH) concentrations. We describe the case of an 83-year-old man presenting with a severe symptomatic hypercalcemia with high-normal PTH level due to the coexistence of primary hyperparathyroidism and malignancy-associated hypercalcemia. The presence of two conditions producing hypercalcemia was revealed only during inhospital stay and after the administration of an intravenous bisphosphonate, when the PTH concentration increased rapidly after bisphosphonate treatment with a decrease in serum calcium. The occurrence of twoconditions producing hypercalcemia is a rare event in the literature, and should be considered in the presence of an abnormally high serum calcium level associated with normal or high-normal PTH, in order to establish a correct diagnosis and appropriate interventions.展开更多
Hypercalcemia presenting in ovarian cancer is uncommon in the clinic.Here,two cases of ovarian epithelial carcinoma that presented with severe hypercalcemia were reported,with a review of the literature.The laboratory...Hypercalcemia presenting in ovarian cancer is uncommon in the clinic.Here,two cases of ovarian epithelial carcinoma that presented with severe hypercalcemia were reported,with a review of the literature.The laboratory findings and stepwise clinical investigations of these two cases differed,indicating distinct underlying causes of hypercalcemia.In case one,the serum levels and immunostaining for parathyroid hormone-related protein(PTHr P)verified humoral hypercalcemia of malignancy(HHM).In case two,the high level of parathyroid hormone(PTH)and the scintigraphy scan showing parathyroid gland adenoma confirmed primary hyperparathyroidism-induced hypercalcemia.Both patients received optimal cytoreductive operation and adjuvant chemotherapy but showed different outcomes respectively.This article focused on differential diagnosis of ovarian cancerassociated hypercalcemia,by stepwise imaging and laboratory investigation,and the appropriate therapy should be considered based on the different etiologies.展开更多
PABCREATIC neuroendocrine tumours are uncommon neoplasms of the pancreas.They may cause a clinical syndrome due to hormone overproduction.Glucagonoma is a rare kind of pancreatic tumors. Here we report a case of gluca...PABCREATIC neuroendocrine tumours are uncommon neoplasms of the pancreas.They may cause a clinical syndrome due to hormone overproduction.Glucagonoma is a rare kind of pancreatic tumors. Here we report a case of glucagonoma. Hypercalcemia occurred when the patient underwent octreotide acetate long-acting release.展开更多
基金Supported by the European Union-Next Generation EU,through the National Recovery and Resilience Plan of the Republic of Bulgaria,No.BG-RRP-2.004-0008.
文摘Despite advancements in the field,early diagnosis of multiple endocrine neoplasia type 1(MEN1)remains unachievable.This letter to the editor highlighted the importance of carefully assessing gastrointestinal symptoms,hypercalcemia,and elevated serum gastrin levels,as suggested by Yuan et al in their paper.They focused on a patient with recurrent abdominal pain and diarrhea whose diagnostic path led to establishing a MEN1 diagnosis within a year.This emphasized the need for clinicians to consider MEN1 in patients with similar presentations,particularly when gastrointestinal symptoms persist or recur after discontinuation of proton pump inhibitors,especially knowing that early recognition and intervention are crucial for improving patient outcomes.
文摘BACKGROUND Calcitriol-induced hypercalcemia has been rarely reported in cases of lung cancer;however,it is frequently reported in cases of lymphoid malignancy and granulomatous disease.We present a rare case of hypercalcemia associated with squamous cell cancer of the lung with elevated calcitriol level.CASE SUMMARY A 61-year-old Caucasian female with severe hypercalcemia of 15 mg/dL,which led to a new diagnosis of metastatic lung cancer.Since the parathyroid hormonerelated peptide(PTHrP)level was minimally elevated at 2.1 pmol/L,we believe excessive calcitriol production by tumor cells was the underlying mechanism for hypercalcemia.Calcitriol was significantly elevated at 130 pg/mL with a low 25-hydroxyvitamin D level of 25.9 ng/mL and suppressed PTH level of 8 pg/mL.Corticosteroids are generally used to treat calcitriol-induced hypercalcemia,but we successfully treated our patient with bisphosphonate,highlighting the further utility of bisphosphonates in hypercalcemia treatment.CONCLUSION We believe that the underlying cause of hypercalcemia,in this case of metastatic squamous cell lung carcinoma,was elevated calcitriol,which was likely produced by the tumor cells.In addition to PTHrP,calcitriol levels should be included in the workup for hypercalcemia in cases of lung cancer.However,the pathophysiology and prognostic significance of dysregulated calcitriol production in solid tumors remain unclear and warrant further research.Bisphosphonate may be used as a steroid-sparing therapy even in cases of calcitriol-induced hypercalcemia and warrants further investigation.
文摘BACKGROUND The association between primary hyperparathyroidism (PHPT) and acute pancreatitis is rarely reported.Here we describe the process of acute pancreatitismediated PHPT induced by hypercalcemia in a male patient.Hypercalcemia induced by undiagnosed PHPT may be the causative factor in recurrent acute pancreatitis.CASE SUMMARY We report a case of hypercalcemia-induced acute pancreatitis caused by a functioning parathyroid adenoma in a 57-year-old man.The patient initially experienced a series of continuous gastrointestinal symptoms including abdominal distension,abdominal pain,nausea,vomiting,electrolyte disturbance,renal dysfunction,and acute pancreatitis.Due to prolonged hypercalcemia,the patient subsequently underwent surgical resection of the parathyroid adenoma.Two weeks after surgery,his serum calcium,amylase,and lipase concentrations were normal.The patient had a good recovery after a series of other relevant therapies.CONCLUSION Acute pancreatitis as the first presentation is a rare clinical symptom caused by PHPT-induced hypercalcemia.
文摘Parathyroid hormone mediated hypercalcemia is not always exclusively primary hyperparathyroidism and rarely could be due to ectopic parathyroid hormone secretion from tumor cells.We present a case of 86-yearold female with metastatic gall bladder adenocarcinoma diagnosed eight months back who presented with generalized fatigue and poor oral intake and was found to be hypercalcemic with elevated parathyroid hormone levels.Imaging with technetium 99 m sestamibi scintigraphy with dual phase,subtraction thyroid scan(dual isotope scintigraphy),magnetic resonance imaging and ultrasonography did not demonstrate any parathyroid lesion in normal or ectopic sites.We believe that the tumor cells were the source of ectopic parathyroid hormone secretion as we had excluded all the other possibilities with extensive combined imaging thereby increasing the sensitivity of our testing.We report the first case of metastatic gall bladder adenocarcinoma with paraneoplastic ectopic parathyroid hormone secretion.
文摘Objective： To evaluate the efficacy and toleration of bisphosphonates therapy in patients with bone metastases and hypercalcemia of malignancy in advanced solid tumor. Methods： Patients with histologically or cytologically confirmed cancer and hypercalcemia with bone metastases were designed to open treatment with either 4mg zoledronic acid or 90mg pamidronate. The primary efficacy parameters were pain scores（NRS）, Corrected serum calcium（CSC） and CSC effective rate The vital signs, biochemical and hematological parameters were determined. Results： Twenty patients were enrolled in this study, twelve patients in zoledronic acid group and eight in pamidronate group. Zoledronic acid and pamidronate significantly palliated pain. Pain scores were significantly lower at end-point after Zoledronic acid or pamidronate infusion（5.92 vs 3.25, P〈0.01; 6.13 vs 4.38, P〈0.01, respectively）. The mean CSC level decreased significantly after Zoledronic acid or pamidronate infusion from 12.86 to 10.28mg/dl and 13.19 to 10.36mg/dl respectively. The CSC effective rate was about 90% at 14 days after infusion in two groups. There was no statistical significance for all primary efficacy parameters in zoledronic acid group compared with pamidronate group. An adverse reaction was mild fever after pamidronate infusion and then completely reversible. Conclusion： Zoledronic acid and pamidronate disodium were well tolerated and effective for bone metastases and hypercalcemia of malignancy in advanced solid tumor.
基金Beijing Municipal Administration of Hospitals Incubating Program,No.PX2018010.
文摘BACKGROUND Although acute pancreatitis associated with hyperparathyroidism has occasionally been reported,acute pancreatitis with metabolic encephalopathy caused by hyperparathyroidism combined with paraneoplastic syndrome is an extremely rare entity and poorly described in the literature.CASE SUMMARY We present a case of a 56-year-old female with upper abdominal discomfort and intermittent nausea and vomiting for 1 wk,without apparent abdominal pain or bloating,no jaundice and decreased blood pressure at the outset.The patient was ultimately diagnosed with moderately severe acute pancreatitis(according to the revised Atlanta classification of acute pancreatitis)combined with metabolic encephalopathy secondary to hypercalcemia caused by primary hyperparathyroidism associated with paraneoplastic syndrome.After active treatment of acute pancreatitis,massive fluid resuscitation,resection of parathyroid and uterine malignant tumors,neoadjuvant chemotherapy and other treatments,her serum calcium eventually returned to the normal level.The patient was successfully discharged from hospital.CONCLUSION This is the first case of acute pancreatitis caused by primary hyperparathyroidism associated with paraneoplastic syndrome.
基金supported by the National Natural Science Foundation of China(nos.81070687 and 81170805)Beijing Natural Science Foundation(no.7121012)+2 种基金Ministry of Science and Technology of the People’s Republic of China(National Science and Technology Major Projects for‘Major New Drugs Innovation and Development 2008ZX09312-016)Scientific Research Foundation of Beijing Medical Development(no.2007-3029)National Key Program of Clinical Science(WBYZ2011-873)
文摘Familial hypocalciuric hypercalcemia （FHH） is caused by inactivating mutations in the calcium-sensing receptor （CaSR） gene. The loss of function of CaSR presents with rickets as the predominant skeletal abnormality in mice, but is rarely reported in humans. Here we report a case of a 16-year-old boy with FHH who presented with skeletal manifestations of rickets. To identify the possible pathogenic mutation, the patient was evaluated clinically, biochemically, and radiographicaUy. The patient and his family members were screened for genetic mutations. Physical examination revealed a pigeon breast deformity and X-ray examinations showed epiphyseal broadening, both of which indicate rickets. Biochemical tests also showed increased parathyroid hormone （PTH）, 1,25-dihydroxyvitamin D, and elevated ionized calcium. Based on these results, a diagnosis of FHH was suspected. Sequence analysis of the patient＇s CaSR gene revealed a new missense mutation （c.2279T 〉 A） in exon 7, leading to the damaging amino change （p.I760N） in the mature CaSR protein, confirming the diagnosis of ~H. Moreover, the skeletal abnormities may be related to but not limited to vitamin D abnormity. Elevated ~H levels and a rapid skeletal growth period in adolescence may have also contributed. Our study revealed that rickets-like features have a tendency to present atypically in FHH patients who have a mild vitamin D deficiency, and that CaSR mutations may have a partial role in the pathogenesis of skeletal deformities.
文摘The hypercalcemias are a common and heterogeneous group of disorders, ranging from the occasional detection of a high level of serum calcium to a life-treating condition. In a patient presenting with hypercalcemia, a differential diagnosis can be established easily by measuring serum calcium and parathyroid hormone(PTH) concentrations. We describe the case of an 83-year-old man presenting with a severe symptomatic hypercalcemia with high-normal PTH level due to the coexistence of primary hyperparathyroidism and malignancy-associated hypercalcemia. The presence of two conditions producing hypercalcemia was revealed only during inhospital stay and after the administration of an intravenous bisphosphonate, when the PTH concentration increased rapidly after bisphosphonate treatment with a decrease in serum calcium. The occurrence of twoconditions producing hypercalcemia is a rare event in the literature, and should be considered in the presence of an abnormally high serum calcium level associated with normal or high-normal PTH, in order to establish a correct diagnosis and appropriate interventions.
基金supported by National Natural Science Foundation of China (Grant No.81402141)General Project of Science and Technology of Tianjin (Grant No.15JCYBJC26600)
文摘Hypercalcemia presenting in ovarian cancer is uncommon in the clinic.Here,two cases of ovarian epithelial carcinoma that presented with severe hypercalcemia were reported,with a review of the literature.The laboratory findings and stepwise clinical investigations of these two cases differed,indicating distinct underlying causes of hypercalcemia.In case one,the serum levels and immunostaining for parathyroid hormone-related protein(PTHr P)verified humoral hypercalcemia of malignancy(HHM).In case two,the high level of parathyroid hormone(PTH)and the scintigraphy scan showing parathyroid gland adenoma confirmed primary hyperparathyroidism-induced hypercalcemia.Both patients received optimal cytoreductive operation and adjuvant chemotherapy but showed different outcomes respectively.This article focused on differential diagnosis of ovarian cancerassociated hypercalcemia,by stepwise imaging and laboratory investigation,and the appropriate therapy should be considered based on the different etiologies.
文摘PABCREATIC neuroendocrine tumours are uncommon neoplasms of the pancreas.They may cause a clinical syndrome due to hormone overproduction.Glucagonoma is a rare kind of pancreatic tumors. Here we report a case of glucagonoma. Hypercalcemia occurred when the patient underwent octreotide acetate long-acting release.
