hypercalcemia

August 12, 2017 17:51 | Assays

hypercalcemia - almost always the result of increased calcium entry into the blood from bone rezorbtsiruemoy or food in a decrease in its renal clearance.More than 90% of cases of hypercalcemia due to primary hyperparathyroidism and malignant neoplasms.

Primary hyperparathyroidism - the main cause of hypercalcemia in outpatients.This is a very common pathology, especially in older women.Approximately 85% of cases of hypercalcemia due to parathyroid adenoma of one of the glands, 15% - hyperplasia of all four glands, and 1% - carcinoma of the parathyroid gland.asymptomatic hypercalcemia, and it usually takes detected incidentally during dispensary surveys.Elevated blood pressure accompanies 30-70% of cases of primary hyperparathyroidism.In these cases, treatment thiazide diuretics may mask hypercalcemia.

Malignancies - the cause of most cases of hyper-perkaltsiemii in hospitalized patients and in the elderly.At the same time, there are two main mechanisms.

■ local osteolytic hypercalcemia, in which tu

mor cells waste products stimulate local bone resorption by osteoclasts.This form of hypercalcemia is only with extensive lesions of bone tumors;often in metastases of breast cancer, multiple myeloma and lymphoma.

■ Humoral paraneoplastic hypercalcemia in which the tumor metabolites have a general effect by stimulating bone resorption and calcium excretion is usually decreasing.Humoral hypercalcemia paraneo-plastic often cause squamous cell carcinoma of the lung, head and neck cancer, esophageal carcinoma, kidney, bladder and ovarian cancers.

Other causes of hypercalcemia are rare.Sarcoidosis, tuberculosis, histoplasmosis may be accompanied by hypercalcemia.The cause of hypercalcemia in these diseases - increased absorption of calcium in the small intestine with the strengthening of education of the active form of vitamin D. Hypercalcemia available in pediatric patients, especially in low-income vitamin D. In these situations, the vitamin content contributes to the normalization of calcium and phosphorus in the blood.Hypercalcemia may be due to intoxication with vitamin D.

comparing laboratory signs of primary hyperparathyroidism, humoral hypercalcemia of paraneoplastic and familial benign hypercalcemia is given in Table ..

Table Laboratory signs of primary hyperparathyroidism, humoral hypercalcemia of paraneoplastic and familial benign hypercalcemia [Lavin N., 1999]

Table Laboratory signs of primary hyperparathyroidism, humoral hypercalcemia of paraneoplastic and familial benign hypercalcemia [Lavin N., 1999]

Note: T - slight increase;TT - a significant increase;I - reduction;H norm.

Note: T - Slight increase;TT - a significant increase;I - reduction;H norm.

incidence of hypercalcemia in peptic ulcer disease is higher than in other types of pathology.Prolonged immobilization with Paget's disease or complex fractures, accompanied by a moderate increase in the phenomena of osteoporosis and calcium in the blood.Steroidindutsirovannuyu gi-perkaltsiemiyu can be observed when receiving androgen, estrogen and GC.Long stay in the patient's bed itself is accompanied by hypercalcemia.The clinical manifestations of pancreatitis are also associated with disorders of calcium metabolism.In the first week of acute pancreatitis may develop hypocalcaemia, which may later be replaced by hypercalcemia.

Clinical manifestations of hypercalcemia is observed in the blood calcium concentration higher than 3 mmol / l, moreover, they are more pronounced during rapid development of hypercalcemia.Renal manifestations include polyuria and urolithiasis.Gastrointestinal disorders include anorexia, nausea, vomiting and constipation.Among the neurological symptoms characterized by weakness, fatigue, confusion, stupor and coma.On an electrocardiogram - a shortening of the QT interval.If the concentration of calcium in the serum exceeds 3.75 mmol / l, and possible renal insufficiency, ectopic calcification of soft tissues.Containing

of serum calcium less than 3 mmol / l corresponds to the light, and above 3.38 mmol / l - severe hypercalcemia.

basis for the study of calcium in serum is considered urolithiasis, bone pathology, hypertension, gout, myopathy, peptic ulcer, pronounced weight loss, pancreatitis.calcium studies conducted in patients with acute renal failure and chronic renal failure, hemodialysis and extracorporeal therapies.Moni-torirovanie calcium is carried out in the course of large surgical interventions, especially with cardiopulmonary bypass.Investigation of calcium in serum is also shown in renal colic, hematuria, pyelonephritis.