Analysis Of Cause And Treatment Of 60 Patients With Hypercalcemia

Background and purpose Hypercalcemia is a clinical emergency that the serum total calcium level is higher than 2.75mmol/L or the ionzed calcium level is higher than 1.75mmol/L.When the serum total calcium level is higher than 3.5mmol/L,the hypercalcemia crisis will occur and it can be life-threatening,so it needs to lower blood calcium level urgently.The key point of treatment is to identify and treat the primary disease.But the clinical manifestations of hypercalcemia usually occur in not only one system,so the primary diseases are eaisy to be misdiagnosed as disease of digestive tract,rheumatic disease and orthopedic diseases.Primary hyperparathyroidism(PHPT)is the most common cause of hypercalcemia.Malignancy-associated hypercalcemia(MAH)is one of the common cause of hypercalcemia.This paper retrospectively analyzes the etiology distribution of 60 hypercalcemia patients on different degreesand the treatments ofhypercalcemia and compares the differences of the laboratory examination between PHPT and MAH.Object and methodThe clinical datas of 60 hypercalcemia patientsin The First Affiliated Hospital of Zhengzhou University hospital from January 2013 to October 2016 were retrospectively analyzed.According to the blood calcium level the patients were divided into mild hypercalcemia2.75 ~ 3mmol/L,moderate hypercalcemia3 ~3.5mmol/L and severe hypercalcemia > 3.5mmol/L.We analyze the etiology distribution of hypercalcemia on different degrees and compare the differences of the laboratory examination between PHPT and MAH and analyze the imaging examination of PHPT and tumorous types of MAH and the treatments ofhypercalcemia.Andfurther studies about the effect and adverse effects of intravenous bisphosphonates and operation in the treatment of PHPT had been done.Results(1)Including 36(60%)PHPT patients,20(33.3%)malignant patients,2(3.3%)hyperthyroidism patients,1(1.7%)vitamin D toxicitypatients,1(1.7%)tertiary hyperparathyroidism patients.9 mild hypercalcemia patientsinclude 8 primary hyperparathyroidism patients and and 1 tertiary hyperparathyroidismpatient.17 moderate hypercalcemia patientsinclude 13 primary hyperparathyroidism patients,2 malignant patients and 2 hyperthyroidism patients.17 moderate hypercalcemia patientsinclude 13 primary hyperparathyroidism patients,2 malignant patients and 2 hyperthyroidism patients.34 severe hypercalcemia patientsinclude 18 malignant patients,15 primary hyperparathyroidism patients and 1 vitamin D toxicity patient.(2)The serum calcium,correction of serum calcium,serum phosphorus and creatinine levels of the MAH were higher than the PHPT[(3.93±0.45 vs 3.30±0.48)mmol/L,(4.08 ± 0.47 vs 3.31 ± 0.52)mmol/L,(1.27 ± 0.41 vs 0.79 ±0.28)mmol/L,(85.33±46.29 vs 174.26±123.08)umol/L,P<0.01].The PTH and blood albumin levels of the MAH were lower than the PHPT{[8.80(6.54,23.59)vs 345.10(199.23,836.25)]pg/ml,(32.91±7.88 vs 39.49±4.32)g/L,P<0.01}.The ALP levels of theirs had no differences(P>0.05).The blood calcium level and correction of serum calcium level had no differences in the PHPT(P>0.05).The correction of serum calcium level was higher than the blood calcium level in theMAH[(4.08±0.47 vs 3.93±0.45)mmol/L,P<0.01].(3)The sensitivity of parathyroid scintigraphy with 99 mTc MIBI(89.3%)was higher than that of ultrasound(68.6%)(P< 0.05)in PHPT.MAH occurred in multiple myeloma and lung cancer,followed by squamous cell carcinoma of the skin.(4)The serum calcium levels of 2 hyperthyroidism patients and 1 vitamin D toxicity patient had been descended in normal range after the treatment of primary diseases.Hypocalcemia was observed in1 tertiary hyperparathyroidismpatient after surgery.The serum calcium levels of 9 patients of 20 malignant patients had been descended below 3.0mmol/L after treatment of lowering calcium levels,and the serum calcium levels of the remain 11 patients had been retained above 3.0mmol/L.(5)After intravenous bisphosphonates,the serum total calcium levels of 9 primary hyperparathyroidism patients who received the treatment of intravenous bisphosphonates decreased from(3.60±0.59)mmol/Lto(2.58±0.41)mmol/Lin(1.89±1.54)days,and were kept below 3.0 mmol/L for(4.44±2.74)days.The adverse effect of pyrexia occurred in 3 patients(33.3%).6 patients with PHPT were treated with conservative treatment,and the other 30 cases were treated with surgery.After surgery,the serum total calcium levels decreased from(2.96±0.37)mmol/Lto(2.41±0.24)mmol/L,and the serum PTH levels decreased from347.45(213.55,840.95)pg/ml to 16.89(8.15,29.96)pg/ml.8 cases(26.7%)had numbness of the mouth and limbs after operation.The PTH levels of 2 patients maintained high levels persistently for 3 months and 1 year separately to return to normal after operation.Conclusions 1.The etiology of hypercalcemia is dominated by PHPT,followed by MAH.The main cause of mild and moderate hypercalcemia is hyperparathyroidism,The main cause of severe hypercalcemia is Malignancy.The correction of serum calcium and serum phosphorus levels of the MAHare higher than the PHPT,as the PTH level of MAH is lower than the PHPT.2.Bisphosphonates are safe and effective in reducing serum calcium levels in patients with PHPT,but the duration is short.So the operation should be carried out as soon as possible during this time.