Hypercalcemia pathophysiology

FIGURE 96-4. Pathophysiology of the hypercalcemia of malignancy. PTHrP, parathyroid hormone-related protein TGF-P, transforming growth factor P TNF-a, tumor necrosis factor alpha Ca2+, calcium IL-1, interleukin 1 IL-2, interleukin 2. 

Stewart AF Clinical practice. Hypercalcemia associated with cancer. N Engl J Med 2005 352 373. [PMID 15673803] Strom TM, Juppner H PHEX, FGF23, DMP1 and beyond. Curr Opin Nephrol Hypertens 2008 17 357. [PMID 18660670] Tfelt-Hanson J, Brown EM The calcium-sensing receptor in normal physiology and pathophysiology A review. Crit Rev... 

Dispersion of physiological concentrations of parathyrine in blood serum influence diurnal rhythm, hourly pulsation, oral load with calcium, exercise, pregnancy, age, and menstrual cycle. There are no sex differences. Medication, resection of a tumor causing hypercalcemia, hypertension, and urolithiasis are the causes of pathophysiological mechanisms that also influence the blood level of parathyrine. Establishing the intact PTH provides sufficient reliability and comparability of the results provided the preanalytic phase is maintained. 

The authors reviewed the causes and pathophysiological mechanisms of nephrogenic diabetes insipidus. They also discussed the metabolic effects of lithium, including renal and thyroid effects, hypercalcemia, leukocytosis, and weight gain. 

Gallium nitrate has been used as an alternative to bisphosphonates in hypercalcemia of malignancy (11), in which it is effective but associated with a higher frequency of renal toxicity (10%) and of nausea and vomiting (14%) than the bisphosphonates. The pathophysiology and treatment of hypercalcemia of malignancy has been reviewed and the role of gallium nitrate considered (12,13). 

Hypercalcemia occurs in horses with chronic renal failure and in a few neoplastic conditions. The clinical signs are usually those of the underlying pathophysiology but soft tissue calcification may occur. In experimental ponies, hypercalcemia induced ventricular fibrillation or cardiac arrest at ionized calcium concentrations of 18.2-40mg/dl (4.55-10.0 mmol/1) (Glazier et al 1979). Treatment for severe hypercalcemia (ionized... 

Nussbaum SR. Pathophysiology and management of severe hypercalcemia. Endocrinol Metab CUn North Am 1993 22 343-362. 

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