Review: Endocrine and metabolic emergencies: hypercalcaemia

Carroll, Richard; Matfin, Glenn

doi:10.1177/2042018810390260

Cited by 41 publications

(35 citation statements)

References 26 publications

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“…Reduced urinary excretion of urate in the presence of high levels of PTH is one of the possible explanations as PTH is known to directly decrease renal tubular secretion of uric acid by down‐regulating a renal urate exporter, ABCG2 . Another possible mechanism is related to hypercalcemia as a high level of calcium is known to cause extracellular volume depletion due to osmotic diuresis and/or partial or complete nephrogenic diabetes insipidus . Although overt hypercalcemia‐related extracellular volume contraction is unusual for patients with PHPT, mild‐to‐moderate degree of extravascular volume contraction can be seen which could enhance renal tubular reabsorption of uric acid …”

Section: Discussionmentioning

confidence: 99%

Primary hyperparathyroidism is associated with a higher level of serum uric acid: A systematic review and meta‐analysis

2019

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Objectives Studies have suggested that primary hyperparathyroidism could be a risk factor for hyperuricemia although the results were not consistent across the studies. This systematic review and meta‐analysis was performed in order to identify all available studies and summarize their results together. Methods A systematic review was performed using EMBASE and MEDLINE from inception to August 2018 to identify all cohort studies that consisted of 2 cohorts, a cohort of patients with primary hyperparathyroidism and a cohort of individuals without hyperparathyroidism. Eligible studies had to provide data on mean serum uric acid level and standard deviation of both cohorts, which would be extracted to calculate mean difference (MD). Pooled MD was then calculated by combining MDs of each study using a random‐effects model. Funnel plot was used for evaluation for publication bias. Results A total of 9 cohort studies met the inclusion criteria and were included into the meta‐analysis. The pooled analysis found that patients with primary hyperparathyroidism had a significantly higher level of serum uric acid than individuals without hyperparathyroidism with the pooled MD of 65.00 μmol/L (95% CI 37.74‐92.25). The statistical heterogeneity was high with I2 of 90%. The funnel plot was relatively symmetric and did not provide evidence for publication bias. Conclusion Patients with primary hyperparathyroidism had a significantly higher level of serum uric acid compared to individuals without hyperparathyroidism.

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Section: Discussionmentioning

confidence: 99%

Primary hyperparathyroidism is associated with a higher level of serum uric acid: A systematic review and meta‐analysis

2019

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“…Hypercalcemia is not exclusively linked to cancer development but is also associated with other pathologies, including hyperparathyroidism (5), granulomatous disease (5), cognitive dysfunction (51), renal failure (52), and cardiac arrhythmia (53). Although these medical conditions are usually symptomatic and typically only emerge during hypercalcemia, which may discriminate them from asymptomatic cancer, the biomedical tattoo could also produce false-positive events and detect medical conditions unrelated to cancer (20,54). Therefore, the use of a biomedical tattoo for the diagnosis of hypercalcemia associated with cancer would be best indicated for individuals with known risk factors for colon cancer [loss of CaSR expression (55), ectopic PTH secretion (56,57), and ulcerative colitis (58,59)] and breast cancer [human epidermal growth factor receptor-2-positive status (38), parathyroid hormone-related protein overexpression (40), and ectopic expression of PTH (60)] and for patients who have undergone primary tumor treatment and require continuous monitoring to diagnose cancer recurrence (41,42), as well as the development of metastases (43,44).…”

Section: Of 11mentioning

confidence: 99%

Synthetic biology-based cellular biomedical tattoo for detection of hypercalcemia associated with cancer

et al. 2018

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Diagnosis marks the beginning of any successful therapy. Because many medical conditions progress asymptomatically over extended periods of time, their timely diagnosis remains difficult, and this adversely affects patient prognosis. Focusing on hypercalcemia associated with cancer, we aimed to develop a synthetic biology-inspired biomedical tattoo using engineered cells that would (i) monitor long-term blood calcium concentration, (ii) detect onset of mild hypercalcemia, and (iii) respond via subcutaneous accumulation of the black pigment melanin to form a visible tattoo. For this purpose, we designed cells containing an ectopically expressed calcium-sensing receptor rewired to a synthetic signaling cascade that activates expression of transgenic tyrosinase, which produces melanin in response to persistently increased blood Ca 2+. We confirmed that the melanin-generated color change produced by this biomedical tattoo could be detected with the naked eye and optically quantified. The system was validated in wild-type mice bearing subcutaneously implanted encapsulated engineered cells. All animals inoculated with hypercalcemic breast and colon adenocarcinoma cells developed tattoos, whereas no tattoos were seen in animals inoculated with normocalcemic tumor cells. All tumor-bearing animals remained asymptomatic throughout the 38-day experimental period. Although hypercalcemia is also associated with other pathologies, our findings demonstrate that it is possible to detect hypercalcemia associated with cancer in murine models using this cell-based diagnostic strategy.

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“…Hypercalcaemia is well known to cause neuropsychiatric symptoms, although this is uncommon below serums adjusted calcium levels of <3.0 mmol/L 7. Hypercalcaemia was initially thought to be the cause of this patient’s symptoms and further investigations into her confusion were not carried out as a presumed diagnosis had been made.…”

Section: Discussionmentioning

confidence: 93%

A case of acute confusion: Cushing’s syndrome presenting with primary hyperparathyroidism

2017

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Cushing's syndrome is a rare disease. Cushing's syndrome presenting as acute psychosis is an exceptional occurrence. We present the case of a 37-year-old woman who was admitted with acute confusion associated with mild hypercalcaemia and was subsequently diagnosed with parathyroid and adrenal adenomas. Our hospital sees approximately 6000 endocrine patients per year, with an incidence of around four Cushing's cases annually. This is the first such case to occur in our hospital and one of few described in the literature.

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Review: Endocrine and metabolic emergencies: hypercalcaemia

Cited by 41 publications

References 26 publications

Primary hyperparathyroidism is associated with a higher level of serum uric acid: A systematic review and meta‐analysis

Primary hyperparathyroidism is associated with a higher level of serum uric acid: A systematic review and meta‐analysis

Synthetic biology-based cellular biomedical tattoo for detection of hypercalcemia associated with cancer

A case of acute confusion: Cushing’s syndrome presenting with primary hyperparathyroidism

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