- MeSH
- Child MeSH
- Hypocalcemia diagnosis etiology MeSH
- Humans MeSH
- Adolescent MeSH
- Calcium therapeutic use MeSH
- Vitamin D therapeutic use MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
- Congress MeSH
DiGeorgův syndrom je nejčastější mikrodeleční syndrom charakterizovaný typickou trias – srdeční vada, imunodeficit a hypokalcemie v důsledku hypoparatyreózy. V této kazuistice prezentuji diagnostický proces u 40letého muže přijatého na interní oddělení s těžkou hypokalcemií.
DiGeorge syndrome is the most common microdeletion syndrome, characterized by the typical triad of symptoms – congenital heart defect, immunodeficiency, and hypocalcaemia due to hypoparathyroidism. In this case report, I describe the diagnostic procedure in a 40-year- old man admitted to our department of internal medicine with severe hypocalcaemia.
- MeSH
- DiGeorge Syndrome * diagnosis complications MeSH
- Adult MeSH
- Hypocalcemia diagnosis drug therapy MeSH
- Hypoparathyroidism diagnosis etiology complications MeSH
- Humans MeSH
- Delayed Diagnosis MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
BACKGROUND/AIMS: Cetuximab is a chimeric antibody registered for the therapy of advanced colorectal carcinoma. Among the side-effects of cetuximab hypomagnesaemia has been described, but the information is still limited. METHODOLOGY: We have evaluated retrospectively serum magnesium, potassium, calcium, creatinine and albumin in 51 consecutive patients with metastatic colorectal carcinoma treated with cetuximab, mostly combined with irinotecan-based combination chemotherapy. RESULTS: A significant decrease of serum magnesium, potassium, calcium and corrected serum calcium, creatinine and albumin concentrations was already evident one week after the start of treatment. Hypomagnesaemia of any grade was detected in 56% of evaluable patients, but grade 3 or grade 4 hypomagnesaemia was observed in 6% and 4% of patients, respectively. Grade 1 hypokalemia was detected in 47%, grade 3 in 17% and grade 4 hypokalemia was detected in 6% of the patients. Among evaluable patients grade 1 hypocalcaemia was detected in (36%), grade 2 hypocalcaemia in 42%, grade 3 in 4% and grade 4 in 13% of patients. Baseline hypocalcaemia of grade 1 or higher was associated with significantly inferior survival. CONCLUSIONS: Asymptomatic hypomagnesaemia, hypokalemia and hypocalcaemia are common in metastatic colorectal carcinoma patients treated with cetuximab. Hypocalcaemia is a predictor of poor prognosis.
- MeSH
- Asymptomatic Diseases MeSH
- Biomarkers blood MeSH
- Time Factors MeSH
- Adult MeSH
- Potassium blood MeSH
- ErbB Receptors antagonists & inhibitors metabolism MeSH
- Magnesium blood MeSH
- Hypocalcemia blood chemically induced MeSH
- Hypokalemia blood chemically induced MeSH
- Protein Kinase Inhibitors adverse effects MeSH
- Kaplan-Meier Estimate MeSH
- Carcinoma drug therapy enzymology mortality secondary MeSH
- Colorectal Neoplasms drug therapy enzymology mortality pathology MeSH
- Creatinine blood MeSH
- Middle Aged MeSH
- Humans MeSH
- Metabolic Diseases blood chemically induced mortality MeSH
- Antibodies, Monoclonal adverse effects MeSH
- Antineoplastic Agents adverse effects MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Serum Albumin metabolism MeSH
- Severity of Illness Index MeSH
- Calcium blood MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Porucha homeostázy kalcia patří k častým komplikacím u onkologicky nemocných, zejména u pacientů s metastatickým postižením kostí. Nerovnováha kostního metabolismu může vést k hyperkalcemii nebo k méně běžnější hypokalcemii. V následujícím článku je formou kazuistiky prezentován pacient s diagnózou karcinomu plic, u něhož byla při příjmu zjištěna závažná hypokalcemie. Po zahájené intravenózní substituční terapii deficitu minerálů bylo v rámci diferenciální diagnostiky hypokalcemie pomýšleno na nedostatek vitaminu D. Následné vyšetření hladiny metabolitu vitaminu D potvrdilo významnou hypovitaminózu. Na základě laboratorních výsledků se v průběhu hospitalizace upravila substituční terapie a byl navržen postup k propuštění pacienta do hospicové péče. Kromě správného managementu hypokalcemie je článek doplněn možnostmi její substituce, jak parenterálními, tak perorálními formami.
Disruption of calcium homeostasis is a common complication in oncological patients, particularly in patients with metastatic bone disorder. Imbalance of bone metabolism may lead to hypercalcaemia or to less common hypocalcaemia. The following article presents a case report of a patient with diagnosis of a lung cancer. Significant hypocalcaemia was detected at the time of hospital admission. After initial intravenous mineral supplementation therapy, the deficiency of vitamin D was considered within the differential diagnosis of hypocalcaemia. Subsequent vitamin D metabolite blood test confirmed serious hypovitaminosis. Based on the laboratory findings, mineral and vitamin D supplementations were adjusted during the hospitalization. The patient was referred to a hospice care. In addition to the correct treatment of hypocalcaemia, this article also includes options of its supplementation, both parenteral and oral.
- Keywords
- suplementace, substituční terapie,
- MeSH
- Avitaminosis drug therapy MeSH
- Carcinoma, Bronchogenic complications MeSH
- Cholecalciferol administration & dosage MeSH
- Calcium Gluconate administration & dosage MeSH
- Magnesium blood MeSH
- Hypocalcemia drug therapy MeSH
- Humans MeSH
- Magnesium Deficiency drug therapy MeSH
- Vitamin D Deficiency drug therapy MeSH
- Palliative Care MeSH
- Aged MeSH
- Magnesium Sulfate administration & dosage MeSH
- Calcium blood MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Publication type
- Case Reports MeSH
Porucha homeostázy kalcia patří k častým komplikacím u onkologicky nemocných, zejména u pacientů s metastatickým posti‑ žením kostí. Nerovnováha kostního metabolismu může vést k hyperkalcemii nebo k méně běžnější hypokalcemii. V následujícím článku je formou kazuistiky prezentován pacient s diagnózou karcinomu plic, u něhož byla při příjmu zjištěna závažná hypo‑ kalcemie. Po zahájené intravenózní substituční terapii deficitu minerálů bylo v rámci diferenciální diagnostiky hypokalcemie pomýšleno na nedostatek vitaminu D. Následné vyšetření hladiny metabolitu vitaminu D potvrdilo významnou hypovitaminózu. Na základě laboratorních výsledků se v průběhu hospitalizace upravila substituční terapie a byl navržen postup k propuštění pacienta do hospicové péče. Kromě správného managementu hypokalcemie je článek doplněn možnostmi její substituce, jak parenterálními, tak perorálními formami.
Disruption of calcium homeostasis is a common complication in oncological patients, particularly in patients with metastatic bone disorder. Imbalance of bone metabolism may lead to hypercalcaemia or to less common hypocalcaemia. The following article presents a case report of a patient with diagnosis of a lung cancer. Significant hypocalcaemia was detected at the time of hospital admission. After initial intravenous mineral supplementation therapy, the deficiency of vitamin D was considered within the differential diagnosis of hypocalcaemia. Subsequent vitamin D metabolite blood test confirmed serious hypovitaminosis. Based on the laboratory findings, mineral and vitamin D supplementations were adjusted during the hospitalization. The patient was referred to a hospice care. In addition to the correct treatment of hypocalcaemia, this article also includes options of its sup‑ plementation, both parenteral and oral.
- MeSH
- Hypocalcemia diagnosis drug therapy MeSH
- Humans MeSH
- Lung Neoplasms * complications MeSH
- Magnesium Deficiency diagnosis drug therapy MeSH
- Vitamin D Deficiency diagnosis drug therapy MeSH
- Palliative Care MeSH
- Aged MeSH
- Vitamin D * therapeutic use MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Case Reports MeSH
Úvod: Incidentálna paratyreoidektómia je jedna z komplikácií chirurgickej liečby ochorení štítnej žľazy. V našej štúdii sme skúmali jej incidenciu, určovali faktory, ktoré zvyšujú riziko incidentálnej paratyreoidektómie, hodnotili jej vplyv na pooperačnú klinickú a laboratórnu hypokalciémiu. Metodika: V retrospektívnej štúdii sme hodnotili 419 pacientov, u ktorých bola vykonaná operácia štítnej žľazy na Klinike ORL a ChHaK JLF UK a UNM v Martine od januára 2011 do decembra 2013. Výskyt náhodného odstránenia prištítneho telieska sme zisťovali na základe výsledkov histologických vyšetrení resekátov. Na spracovanie výsledkov a určenie miery štatistickej významnosti sme použili CHI- kvadrát test. Výsledky: Z celkového počtu 419 chorých bola incidentálna paratyreoidektómia potvrdená u 26 pacientov (6.2 %), u 3 chorých z tohto počtu boli náhodne extirpované 2 prištítne telieska. Pooperačné laboratórne príznaky hypokalciémie sme pozorovali u 133 pacientov (31,74 %), klinické príznaky sa vyskytovali u 29 pacientov (6,92 %). Z 26 chorých s potvrdenou incidentálnou paratyreoidektómiou malo klinické a laboratórne príznaky hypokalciémie 5 pacientov (19,23 %). V súbore 393 chorých, u ktorých boli prištítne telieska zachované, sme laboratórnu hypokalciémiu potvrdili u 128 pacientov (32,57 %), u 24 chorých (6,1 %) bola laboratórna hypokalciémia sprevádzaná aj klinickými prejavmi. Potvrdili sme štatisticky významne vyšší výskyt parestézíí u pacientov s náhodne exstirpovaným prištítnym telieskom (P=0,01). Pri hodnotení vplyvu histologickej diagnózy na výskyt incidentálnej paratyreoidektómie sme potvrdili štatisticky významne vyšší výskyt náhodného odstránenia prištítneho telieska pri papilárnom karcinóme štítnej žľazy (P<0,05). Rozsah výkonu nemal štatisticky významný vplyv na výskyt incidentálnej paratyreoidektómie (P>0,05). Záver: Papilárny karcinóm štítnej žľazy je rizikový faktor výskytu incidentálnej paratyreoidektómie. U pacientov s náhodne odstráneným prištítnym telieskom je výskyt parestézií vyšší.
Introduction: Incidental parathyroidectomy is one of the complications of thyroid surgery. In this study, we investigated the frequency, risk factors, clinical and laboratory symptoms of incidental parathyroidectomy. Materials and methods: The retrospective study included 419 patients who had undergone thyroid surgery in our department between January 2011 and December 2013. The incidental parathyroidectomy was identified based on the pathological reports. For statistical purpose we use the CHI – test. Results: 419 patients were enrolled in the study. The number of incidental parathyroidectomy cases was determined as 26 (6.2%). In 3 cases, two parathyroid glands were excised. The laboratory values of hypocalcaemia were observed in 133 patients (31.74%), 29 of them had clinical symptoms of hypocalcaemia (6.92%). In the group of 26 patients with the incidental parathyroidectomy, there were 5 of them with clinical and laboratory signs of hypocalcaemia. In the group of 393 patients without incidental parathyroidectomy, there were 128 patients (32.57%) with low calcium levels and 24 patients (6.1%) with clinical signs of hypocalcaemia. In the group of patients with incidental parathyroidectomy the rate of clinical signs of hypocalcaemia was statistically higher (P=0.01). Risk factors for inadvertent parathyroid resection included malignant etiology (P<0.05). Bilateral thyroid resection wasn't significant risk factor (P>0.05). Conclusion: Papillary thyroid carcinoma is the risk factor of the incidental parathyroidectomy. In the group of patients with incidental parathyroidectomy the rate of symptomatic hypocalcaemia is significantly higher.
Hypocalcaemia of various origin can be manifested by paresthesia, muscle cramps, muscle weakness, syncope, convulsions and even severe psychomotor retardation. Such symptoms can be initially considered as signs of epilepsy. We present a 12- year old boy with partial seizures and basal ganglia calcifications, initially diagnosed as having Fahr ́s disease and epilepsy, where severe hypocalcaemia, due to genetically confirmed pseudohypoparathyroidism type Ib was the underlying cause. Excellent clinical improvement was observed after calcium and vitamin D therapy. The basal ganglia calcifications were secondary due to chronic hypocalcaemia, therefore the appropriate diagnosis was pseudohypoparathyroidism type Ib with Fahr ́s syndrome, but not Fahr ́s disease. In conclusion, the serum evaluation of minerals, especially calcium and phosphate, should be performed in all patients with convulsions, cramps and psychomotor retardation. This is essential in arriving at a proper diagnosis and early initiation of appropriate treatment.
- MeSH
- Child MeSH
- Epilepsy * complications MeSH
- Hypocalcemia * complications MeSH
- Humans MeSH
- Pseudohypoparathyroidism * complications diagnosis MeSH
- Calcium therapeutic use MeSH
- Seizures etiology MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
Pseudohypoparathyreóza (PHP) je heterogénna skupina chorôb charakterizovaná hypokalciémiou, hyperfosfatémiou, zvýšenou hladinou parathormónu v sére a rezistenciou cieľových tkanív na parathormón. Táto veľmi ojedinelá diagnóza je spojená s molekulárnym defektom, ktorý sa môže prejaviť už v detstve. Prezentujeme kazuistiku pacientky s Downovým syndrómom a Gravesovou-Basedowovou chorobou, ktorá bola hospitalizovaná pre hypokalciémiu ťažkého stupňa. Po sérii diagnostických vyšetrení sa podarila stanoviť vzácna diagnóza PHP typ 1b. Po komplexnom endokrinologickom vyšetrení bola indikovaná na tyreoidektómiu s konkomitantnou exstirpáciou prištítnych teliesok. Pri tomto zákroku bolo jedno prištítne teliesko implatované do kývača.
Pseudohypoparathyreoidismus (PHP) is a heterogeneous group of disorders characterized by hypocalcaemia, hyperphosphatemia, increased serum concentration of parathyroid hormone and target tissue resistance only to parathyroid hormone. This highly unique diagnosis is associated with the molecular defect which may occur in childhood. We present a case report of a patient with Down syndrome and Graves-Basedow disease who was hospitalized because severe hypocalcaemia. She was diagnosed with PHP type 1b after a series of tests. She was indicated to extirpation of all parathyroid glands during bilateral thyroidectomy after a comprehensive endocrinological examination. One parathyroid gland was immediately autotransplanted into the sternocleidomastoid muscle.
- MeSH
- Avitaminosis diagnosis MeSH
- Adult MeSH
- Down Syndrome * diagnosis complications metabolism MeSH
- Graves Disease * diagnosis complications metabolism MeSH
- Hyperphosphatemia diagnosis metabolism MeSH
- Hypocalcemia diagnosis metabolism MeSH
- Humans MeSH
- Malabsorption Syndromes diagnosis complications metabolism MeSH
- Vitamin D Deficiency diagnosis etiology therapy MeSH
- Pseudohypoparathyroidism diagnosis complications metabolism MeSH
- Statistics as Topic MeSH
- Thyroidectomy * methods utilization MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
