scholarly journals Approach to hypercalcemia

2022 ◽  
Vol 20 (1) ◽  
Author(s):  
Sophy Mo
Keyword(s):  
Differential Diagnosis ◽  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Physical Examination ◽  
Clinical Setting ◽  
Systematic Approach ◽  
History Taking ◽  
Laboratory Investigations ◽  
Main Components

Hypercalcemia is a presentation commonly encountered in the clinical setting. Due to its vast differential diagnosis, a systematic approach is necessary when approaching patients with hypercalcemia. This article presents a simple, yet thorough approach to help clinicians determine the etiology of their patient's hypercalcemia. The main components of history taking, physical examination, and laboratory investigations for patients with hypercalcemia are highlighted. Emphasis is put on the importance of determining whether the hypercalcemia is associated with elevated or inappropriately normal parathyroid hormone (PTH) or not. The main etiologies of PTH-dependent hypercalcemia and PTH-independent hypercalcemia are explored. Primary hyperparathyroidism and hypercalcemia secondary to malignancy are highlighted as together, they make up 90% of hypercalcemia cases. A presentation of the management principles of hypercalcemia is also provided.

The limping child

2013 ◽  
pp. 100-107
Author(s):  
Yukiko Kimura ◽  
Taunton R. Southwood
Keyword(s):  
Differential Diagnosis ◽  
Physical Examination ◽  
Laboratory Testing ◽  
Systematic Approach ◽  
Diagnostic Algorithms ◽  
Musculoskeletal Examination ◽  
Careful History

This chapter presents a systematic approach to evaluating the limping child, beginning with a careful history, then the physical examination, and proceeding to the musculoskeletal examination followed by targeted investigations. Tables with useful tips for differential diagnosis based on age and laboratory testing, as well as diagnostic algorithms, are presented.

The limping child

2013 ◽  
Author(s):  
Yukiko Kimura ◽  
Taunton R. Southwood
Keyword(s):  
Differential Diagnosis ◽  
Physical Examination ◽  
Laboratory Testing ◽  
Systematic Approach ◽  
Diagnostic Algorithms ◽  
Musculoskeletal Examination ◽  
Careful History

This chapter presents a systematic approach to evaluating the limping child, beginning with a careful history, then the physical examination, and proceeding to the musculoskeletal examination followed by targeted investigations. Tables with useful tips for differential diagnosis based on age and laboratory testing, as well as diagnostic algorithms, are presented.

General assessment and preliminary assessment following injuries

2005 ◽  
pp. 1-55
Author(s):  
Patricia Sylla
Keyword(s):  
Differential Diagnosis ◽  
Physical Examination ◽  
The Elderly ◽  
History Taking ◽  
Preliminary Assessment ◽  
The Past ◽  
Multiple Injured ◽  
Drug History ◽  
Injured Patients ◽  
Multiple Injured Patients

History taking and physical examination 2 The significance of the past medical, social, and drug history in assessing emergencies and admissions 8 Assessment of patients undergoing surgery 12 Assessing the elderly 18 Physical examination 20 Differential diagnosis of 'the swollen face' by region 24 Preliminary assessment of multiple-injured patients—general points ...

scholarly journals Feline Hypertrophic Osteopathy Associated with Congenital Megaesophagus: Two Case Reports and Literature Review

2020 ◽  
Vol 71 (3) ◽  
pp. 2413
Author(s):  
A.M. ABU-SEIDA ◽  
F.A. TORAD ◽  
E.A. HASSAN ◽  
K.M. ALI
Keyword(s):  
Differential Diagnosis ◽  
Physical Examination ◽  
Case Reports ◽  
Clinical Signs ◽  
Appendicular Skeleton ◽  
Long Bones ◽  
New Bone Formation ◽  
Thoracic Radiography ◽  
Laboratory Findings ◽  
Laboratory Investigations

This report describes two cases of feline hypertrophic osteopathy (HO) associated with congenital megaesophagus (ME). The diagnosis was based upon case history, physical examination, radiography and laboratory investigations. The clinical signs of both cats included; regurgitation, weakness and reluctance to walk since birth. Physical examination revealed painful and thickened long bones, swollen joints, difficult flexion of all four limbs and normal urination, defecation, appetite as well as heart and respiratory rates. The abnormal laboratory findings were thrombocytosis, leukocytosis with lymphocytosis and monocytosis. Survey and contrast thoracic radiography showed generalizedesophageal dilatation. Radiography of appendicular skeleton revealed symmetrical and massive subperiosteal new bone formation of the affected long bones and pelvis. In conclusion, radiography of extremities is highly recommended for cats admitted with congenital ME and lameness to investigate the possibility of HO. Moreover, the HO should be listed duringthe differential diagnosis of thickened limbs in cats.

scholarly journals Familial hypocalciuric hypercalcemia as a differential diagnosis of primary hyperparathyroidism with negative images

Medunab ◽  
2022 ◽  
Vol 24 (3) ◽  
pp. 347-352
Author(s):  
Edwin Antonio Wandurraga-Sánchez ◽  
Mario Alejandro Buitrago-Gómez ◽  
María Camila Uribe-Forero ◽  
Nestor Andrés Díaz-Posada ◽  
María Camila Amaya-Muñoz
Keyword(s):  
Differential Diagnosis ◽  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Creatinine Clearance ◽  
Parathyroid Adenoma ◽  
Receptor Gene ◽  
Hormone Secretion ◽  
Familial Hypocalciuric Hypercalcemia ◽  
Clearance Ratio ◽  
Metabolism Disorder

Introduction. Familial hypocalciuric hypercalcemia is a rare inherited calcium metabolism disorder in which an alteration of the parathyroid hormone secretion set-point causes hypercalcemia with relative hypocalciuria. Some data suggest that its prevalence is around 74.1 per 100,000 inhabitants. Often, patients are asymptomatic. However, they can develop mild symptoms and an overactive parathyroid adenoma, its main differential diagnosis. The objective was to describe a patient’s case and highlight the importance of clinical suspicion and diagnosis to avoid unnecessary surgical neck explorations for parathyroid adenomas. Case report. This is the case of a 40-year-old man with a biochemical profile compatible with primary hyperparathyroidism with anatomical and functional images negative for adenoma and a calcium/creatinine clearance ratio below 0.001, considering familial hypocalciuric hypercalcemia. Genetic studies evidence a mutation in the calcium sensor receptor gene and confirm the diagnosis. Discussion. Familial hypocalciuric hypercalcemia’s main differential diagnosis is an overactive parathyroid adenoma. For both, mild or no symptoms may be present; serum calcium exceeds the upper limit, and parathormone is more than 25pg/ml. The calcium/creatinine clearance ratio should be used to differentiate one from the other and avoid unnecessary surgical neck explorations. Besides the lack of information on this topic, evidence supports the use of calcimimetics to treat symptomatic hypercalcemia. Conclusions. Patients with mild hypercalcemia with parathyroid hormone readings above 25pg/ml and a calcium/creatinine clearance ratio below 0.001, or patients with primary hyperparathyroidism with negative imaging, should not undergo surgical neck explorations. In these cases, familial hypocalciuric hypercalcemia is a reliable diagnosis; Cinacalcet may be administered in cases of symptomatic hypercalcemia.

Immunochemiluminometric and immunoradiometric determinations of intact and total immunoreactive parathyrin: performance in the differential diagnosis of hypercalcemia and hypoparathyroidism

1991 ◽  
Vol 37 (2) ◽  
pp. 162-168 ◽  
Author(s):  
David B Endres ◽  
Rocheile Villanueva ◽  
Charles F Sharp ◽  
FrederIck R Singer
Keyword(s):  
Renal Function ◽  
Differential Diagnosis ◽  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Normal Subjects ◽  
Intact Pth ◽  
Marked Contrast ◽  
Low Concentrations ◽  
Selection Of ◽  
Serum Effect

Abstract Parathyrin (parathyroid hormone; PTH) was measured with three immunoassays: a two-site immunochemiluminometric (ICMA) and a two-site immunoradiometric (IRMA) method for intact PTH, and a sensitive radioimmunoassay for mid-region or "total" PTH, measuring both intact hormone and inactive fragments. Single specimens from normal subjects and from individuals with primary hyperparathyroidism, hypercalcemia associated with malignancy, and hypoparathyroidism were analyzed with all three methods. All individuals with primary hyperparathyroidism showed absolutely above-normal concentrations with the mid-region RIA, 28 of 29 did with the ICMA, and 21 of 29 did with the IRMA. PTH concentrations in primary hyperparathyroidism were most increased relative to normal subjects with the mid-region assay (10.4 times), less so with the intact assays (ICMA 5.5 times; IRMA 5.3 times). Concentrations of intact PTH were suppressed below normal in nearly all patients with hypercalcemia associated with malignancy, as measured with the ICMA (26 of 30) and the IRMA (28 of 30) assays. In marked contrast, results for mid-region PTH were normal or slightly above normal, consistent with studies suggesting that the parathyroids secrete both intact hormone and inactive fragments, the former being more sensitive to suppression by hypercalcemia. In hypoparathyroidism PTH concentrations were detectable but below normal in all patients by the intact assays and in all but one patient by the mid-region assay. These low concentrations are probably due to a nonspecific serum effect that could be resolved with selection of a more appropriate standard matrix. Although all three assays are useful in the differential diagnosis of hypercalcemia, two-site intact assays are more convenient and more specific in patients with compromised renal function.

PARATHYROID HORMONE SECRETION IN DISORDERS OF CALCIUM METABOLISM STUDIED BY MEANS OF EDTA

1974 ◽  
Vol 75 (2) ◽  
pp. 286-296 ◽  
Author(s):  
J. H. Lockefeer ◽  
W. H. L. Hackeng ◽  
J. C. Birkenhäger
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Calcium Metabolism ◽  
Hormone Secretion ◽  
Parathyroid Tissue ◽  
Small Mass ◽  
Idiopathic Hypercalciuria ◽  
List Type ◽  
Immunoreactive Parathyroid Hormone ◽  
Pth Level

ABSTRACT In 22 of 28 cases of primary hyperparathyroidism (PHP) the rise in the serum immunoreactive parathyroid hormone (IRPTH or PTH) level observed in response to lowering of the serum calcium by EDTA, exceeded that obtained in 8 control subjects. In 5 of these 22 patients who were studied again after parathyroidectomy the supranormal response was abolished. Fifteen of these 22 hyper-responsive PHP patients had basal IRPTH levels not exceeding the highest level in the controls and that of other groups of patients investigated (idiopathic hypercalciuria, non-parathyroid hypercalcaemia, operated PHP). Fourteen of the 22 hyper-reactive patients with PHP did not show hypocalcaemia during the infusion of EDTA. The extent of the release of PTH elicited by EDTA in cases of PHP does not as yet allow a prediction of the amount of pathological parathyroid tissue present, although all the PHP patients showing a normal release of PTH had a relatively small mass of parathyroid tissue (up to about 1 g) subsequently removed. In 9 cases of nephrolithiasis (8 of whom had idiopathic hypercalciuria) and in 7 cases of non-parathyroid hypercalcaemia, a normal PTH release was found.

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