Non-Hodgkin's Malignant Lymphoma of the Bone  with Intracavitary Cardiac Involvement.

Satô, Hiroshi; Takahashi, Motoi

doi:10.2169/internalmedicine.32.502

Cited by 7 publications

(3 citation statements)

References 12 publications

(12 reference statements)

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“…Although hypercalcemia as a complication of B-lymphoma with multiple lytic bone lesions has been reported [5], we cannot suggest a mechanism for the development of hypercalcemia in our case, where no lytic bone involvement was evident. Also, no indication exists that congenital dyserythropoiesis may contribute to this unusual liver calcification.…”

Section: Diffuse Hepatic Calcinosis and Hypercalcemia In Association contrasting

confidence: 56%

Paroxysmal nocturnal hemoglobinuria: Golden standards vs. modern technologies

et al. 1995

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Section: Diffuse Hepatic Calcinosis and Hypercalcemia In Association contrasting

confidence: 56%

Paroxysmal nocturnal hemoglobinuria: Golden standards vs. modern technologies

et al. 1995

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Section: Diffuse Hepatic Calcinosis and Hypercalcemia In Association contrasting

confidence: 56%

Editorial Comment

Conrad

1995

American J Hematol

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“…[8][9][10] This has led many workers to suggest that PTHrP does not stimulate renal 1α-hydroxylase activity in patients with humoral hypercalcaemia of malignancy. 11 12 However Schweitzer et al, 12 Sato and Takahashi, 13 and Ralston et al 8 have commented on the fact that 1,25(OH) 2 D 3 levels are frequently not suppressed in humoral hypercalcaemia of malignancy, consistent with a stimulatory effect of PTHrP on 1α-hydroxylase activity. In keeping with this hypothesis, serum 1,25(OH) 2 D 3 levels are increased in various animal models of PTHrP mediated humoral hypercalcaemia of malignancy.…”

Section: Discussionmentioning

confidence: 99%

Presentation of a PTHrP-secreting pancreatic neuroendocrine tumour, with hypercalcaemic crisis, pre-eclampsia, and renal failure

Abraham

Ralston

Hewison

et al. 2002

Postgraduate Medical Journal

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Severe hypercalcaemia during pregnancy is rare and most cases are secondary to hyperparathyroidism. This is the first report of a parathyroid hormone related protein (PTHrP) secreting neuroendocrine tumour of the pancreas manifesting with severe hypercalcaemia during pregnancy. Measurement of PTHrP was useful in both the diagnosis and follow up of our patient and should be considered in the diagnostic workup of patients with unexplained hypercalcaemia. A raised PTHrP concentration is a strong indicator of malignancy. S evere hypercalcaemia is rare during pregnancy. Most cases are due to hyperparathyroidism but there are fewer than 150 patients reported in world literature.1 There have been two reports of the milk alkali syndrome 2 and four reported cases of parathyroid carcinoma during pregnancy. 3Other cases of malignancy related hypercalcaemia in pregnancy are very rare.Parathyroid hormone related protein (PTHrP) was first isolated in 1987 from cancer cell lines and a tumour associated with hypercalcaemia, and is now considered to be the main mediator of humoral hypercalcaemia of malignancy.4 5 The placenta (during pregnancy) and mammary glands (postpartum) are important physiological sources of PTHrP. 6 We report a case of extreme hypercalcaemia manifesting during pregnancy. The hypercalcaemia was associated with raised levels of 1,25-dihydroxyvitamin D 3 (1,25(OH) 2 D 3 ) and was eventually found to be due to a PTHrP secreting pancreatic neuroendocrine tumour. CASE REPORTA 25 year old woman presented at 29 weeks' gestation with altered consciousness, headache, hypertension and proteinuria, and was initially thought to have pre-eclampsia. She was noted to have taken 1 g of mefenamic acid in divided doses during the two days before presentation.Her initial investigations showed a serum calcium adjusted for albumin of 5.9 mmol/l (reference range 2.2-2.6). A retrospective measurement of calcium at 19 weeks' gestation was obtained at 2.33 mmol/l. Her serum phosphate was raised at 2.07 mmol/l (reference range 0.7-1.2), probably as a result of her renal impairment. She had renal failure with a serum creatinine of 328 µmol/l (reference range 60-110) and her 24 hour urinary protein was 9.09 g. Parathyroid hormone was undetectable using a two site immunoradiometric assay (Diagnostic Product Corporation Immulite, Los Angeles USA).Her early management consisted of an emergency caesarean section followed by transfer to the intensive therapy unit. She was given five intravenous doses of pamidronate 15 mg twice daily. In the postpartum period calcium decreased rapidly after pamidronate and she required calcium supplements for one month. The calcium decreased to a nadir of 1.9 mmol/l then subsequently steadily increased to 2.68 mmol/l at 12 months and 2.76 mmol/l at 15 months. Her renal function improved rapidly with serum creatinine decreasing to 99 µmol/l at 10 days but the proteinuria took six months to normalise.Serum parathyroid hormone concentrations were undetectable on three occasions between three and 12 months ...

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Non-Hodgkin's Malignant Lymphoma of the Bone with Intracavitary Cardiac Involvement.

Cited by 7 publications

References 12 publications

Paroxysmal nocturnal hemoglobinuria: Golden standards vs. modern technologies

Paroxysmal nocturnal hemoglobinuria: Golden standards vs. modern technologies

Editorial Comment

Presentation of a PTHrP-secreting pancreatic neuroendocrine tumour, with hypercalcaemic crisis, pre-eclampsia, and renal failure

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